Provider Demographics
NPI:1902096753
Name:STRAIT, JULIE ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELLEN
Last Name:STRAIT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 HALL RD
Mailing Address - Street 2:LOT 45
Mailing Address - City:BEAVER DAMS
Mailing Address - State:NY
Mailing Address - Zip Code:14812-9715
Mailing Address - Country:US
Mailing Address - Phone:607-857-2389
Mailing Address - Fax:
Practice Address - Street 1:1231 HALL RD
Practice Address - Street 2:LOT 45
Practice Address - City:BEAVER DAMS
Practice Address - State:NY
Practice Address - Zip Code:14812-9715
Practice Address - Country:US
Practice Address - Phone:607-857-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277442164W00000X
NY605419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02860777Medicaid