1194969345 NPI number — MRS. JULIE ANN CHANG CRNP

Table of content: MRS. JULIE ANN CHANG CRNP (NPI 1194969345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194969345 NPI number — MRS. JULIE ANN CHANG CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERTSON
Provider Other First Name:
JULIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194969345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 WOODENS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMBERTVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08530-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-939-1473
Provider Business Mailing Address Fax Number:
636-212-8372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE CHILDREN'S HOSPITAL OF PHILADELPHIA - CARDIAC DEPT
Provider Second Line Business Practice Location Address:
34TH STREET & CIVIC CENTER BOULEVARD
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-939-1473
Provider Business Practice Location Address Fax Number:
215-590-5415
Provider Enumeration Date:
04/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP010244 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)