Healthcare Provider Details

I. General information

NPI: 1528702719
Provider Name (Legal Business Name): JULIAN AVERY ARMSTRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2022
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 S WOLF RD APT 415
HILLSIDE IL
60162-2123
US

IV. Provider business mailing address

2021 S WOLF RD APT 415
HILLSIDE IL
60162-2123
US

V. Phone/Fax

Practice location:
  • Phone: 870-717-4115
  • Fax:
Mailing address:
  • Phone: 870-717-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number231677
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1074632
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024196657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: