Provider Demographics
NPI:1528702719
Name:ARMSTRONG, JULIAN AVERY
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:AVERY
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 S WOLF RD APT 415
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2123
Mailing Address - Country:US
Mailing Address - Phone:870-717-4115
Mailing Address - Fax:
Practice Address - Street 1:2021 S WOLF RD APT 415
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2123
Practice Address - Country:US
Practice Address - Phone:870-717-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074632367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered