Provider Demographics
NPI:1548966732
Name:VANOSDOL, JULIA MARIE
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MARIE
Last Name:VANOSDOL
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 1:655 S HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3430
Mailing Address - Country:US
Mailing Address - Phone:208-380-0470
Mailing Address - Fax:
Practice Address - Street 1:655 S HAYES AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3430
Practice Address - Country:US
Practice Address - Phone:208-380-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider