=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427760065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE FORD CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2022
-----------------------------------------------------
Last Update Date | 12/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 PIKE ST
-----------------------------------------------------
City | HUNTINGDON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16652-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 348 TOFTREES AVE APT 362
-----------------------------------------------------
City | STATE COLLEGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16803-2056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-769-9308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP026777
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------