Provider Demographics
NPI:1285251553
Name:JANSON, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STELLA COURT
Mailing Address - Street 2:#221 (LENORA ISAACS)
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1011
Mailing Address - Country:US
Mailing Address - Phone:614-502-7812
Mailing Address - Fax:614-252-7987
Practice Address - Street 1:2100 STELLA COURT
Practice Address - Street 2:#221 (LENORA ISAACS)
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1011
Practice Address - Country:US
Practice Address - Phone:614-502-7812
Practice Address - Fax:614-252-7987
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker