Provider Demographics
NPI:1861718322
Name:LISTER, JULIE (NP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:LISTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2010 ZONAL AVE
Mailing Address - Street 2:3P-61
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0121
Mailing Address - Country:US
Mailing Address - Phone:323-226-2742
Mailing Address - Fax:323-226-2573
Practice Address - Street 1:2010 ZONAL AVE
Practice Address - Street 2:3P-61
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0121
Practice Address - Country:US
Practice Address - Phone:323-226-2742
Practice Address - Fax:323-226-2573
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily