Healthcare Provider Details

I. General information

NPI: 1649693037
Provider Name (Legal Business Name): JULIA L REODICA RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SW GAINES ST
PORTLAND OR
97239-7403
US

IV. Provider business mailing address

1012 SW GAINES ST
PORTLAND OR
97239-7403
US

V. Phone/Fax

Practice location:
  • Phone: 858-367-3672
  • Fax:
Mailing address:
  • Phone: 858-367-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN727268
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number592944
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number200943239RN
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1013361
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: