Healthcare Provider Details

I. General information

NPI: 1184677247
Provider Name (Legal Business Name): JULIETA S POPE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

80 HURON AVE
ALBANY NY
12203-2620
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300854-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: