Healthcare Provider Details

I. General information

NPI: 1609784792
Provider Name (Legal Business Name): JULIA NIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BERGEN ST
NEWARK NJ
07107-3001
US

IV. Provider business mailing address

65 BERGEN ST
NEWARK NJ
07107-3001
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4307
  • Fax:
Mailing address:
  • Phone: 973-972-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR27885800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number772735
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: