Provider Demographics
NPI:1265075519
Name:RAISTRICK, JULIA ANN
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:RAISTRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-3316
Mailing Address - Country:US
Mailing Address - Phone:209-341-0718
Mailing Address - Fax:
Practice Address - Street 1:609 5TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-3316
Practice Address - Country:US
Practice Address - Phone:209-341-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician