Provider Demographics
NPI:1215236237
Name:LLERA, JULIE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:LLERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BLANCHARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-1905
Mailing Address - Country:US
Mailing Address - Phone:315-345-7138
Mailing Address - Fax:
Practice Address - Street 1:111 BLANCHARD BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1905
Practice Address - Country:US
Practice Address - Phone:315-345-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288435-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse