Provider Demographics
NPI:1811679244
Name:JULIAN, MIRANDA (HIS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:JULIAN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL STE 510
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1102
Mailing Address - Country:US
Mailing Address - Phone:401-475-6116
Mailing Address - Fax:401-475-6616
Practice Address - Street 1:6 BLACKSTONE VALLEY PL STE 510
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1102
Practice Address - Country:US
Practice Address - Phone:401-475-6116
Practice Address - Fax:401-475-6616
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHAD00307237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist