1023720695 NPI number — JULIANA BARBARA IVANOF CPNP-PC

Table of content: JULIANA BARBARA IVANOF CPNP-PC (NPI 1023720695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023720695 NPI number — JULIANA BARBARA IVANOF CPNP-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVANOF
Provider First Name:
JULIANA
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP-PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023720695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 WHITING HILL RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04412-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-5000
Provider Business Mailing Address Fax Number:
207-973-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 CORPORATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-941-1155
Provider Business Practice Location Address Fax Number:
207-945-5063
Provider Enumeration Date:
12/15/2022

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: 363LP0200X , with the licence number:  CNP221594 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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