Provider Demographics
NPI:1972661338
Name:TOMLINSON, JULIANNA (CRNFA)
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 MONTARA DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-2170
Mailing Address - Country:US
Mailing Address - Phone:541-773-2404
Mailing Address - Fax:541-779-4824
Practice Address - Street 1:2668 MONTARA DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-2170
Practice Address - Country:US
Practice Address - Phone:541-773-2404
Practice Address - Fax:541-779-4824
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088006773RN364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR093328Medicaid