Healthcare Provider Details

I. General information

NPI: 1962134098
Provider Name (Legal Business Name): KATILYN EMANI JULIAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE ROAD H1
CHERRY HILL NJ
08034
US

IV. Provider business mailing address

624 SCHAEFFER AVE
WOODBURY NJ
08096-6632
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-0389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR19124200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01431500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: