Provider Demographics
NPI:1861600082
Name:DENNISTON, JULIA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DENNISTON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 STONECASTLE CT
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1178
Mailing Address - Country:US
Mailing Address - Phone:925-683-1933
Mailing Address - Fax:925-935-8491
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4904
Practice Address - Country:US
Practice Address - Phone:925-683-1933
Practice Address - Fax:925-935-8491
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392957163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant