Healthcare Provider Details

I. General information

NPI: 1669824603
Provider Name (Legal Business Name): JULIA K. BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA KATHRYN CAMPBELL

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S ATHERTON ST STE 5
STATE COLLEGE PA
16801-8324
US

IV. Provider business mailing address

3901 S ATHERTON ST STE 5
STATE COLLEGE PA
16801-8324
US

V. Phone/Fax

Practice location:
  • Phone: 814-466-7921
  • Fax: 814-466-6570
Mailing address:
  • Phone: 814-466-7921
  • Fax: 814-466-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN620254
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP016411
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: