Provider Demographics
NPI:1104645522
Name:STREETER, JULIA ELIZABETH
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ELIZABETH
Last Name:STREETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:STREETER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JULIA ADAMS
Mailing Address - Street 1:131 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2700
Mailing Address - Country:US
Mailing Address - Phone:315-380-1480
Mailing Address - Fax:
Practice Address - Street 1:131 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-2700
Practice Address - Country:US
Practice Address - Phone:315-380-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY834938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse