Basic Information
| Provider Information | |||||||||
| NPI: | 1710112073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SZYMANSKI | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 CLARION RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158451656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143894411 | ||||||||
| FaxNumber: | 8143894142 | ||||||||
| Practice Location | |||||||||
| Address1: | 81 CLARION RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158451656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143894411 | ||||||||
| FaxNumber: | 8143894142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2009 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | MW010195 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 102321036 | 05 | PA | MEDICAID |