Basic Information
| Provider Information | |||||||||
| NPI: | 1174910020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLOCK | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28947 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937298947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592614500 | ||||||||
| FaxNumber: | 5592241825 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 E RIVER PARK CIR | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937201571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592614500 | ||||||||
| FaxNumber: | 5592241825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2015 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 612074 | CA | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.