Basic Information
Provider Information | |||||||||
NPI: | 1366437469 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUSTON | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2580 HAYMAKER RD STE 201 | ||||||||
Address2: |   | ||||||||
City: | MONROEVILLE | ||||||||
State: | PA | ||||||||
PostalCode: | 151463500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4128567500 | ||||||||
FaxNumber: | 4128566079 | ||||||||
Practice Location | |||||||||
Address1: | 2580 HAYMAKER RD STE 201 | ||||||||
Address2: |   | ||||||||
City: | MONROEVILLE | ||||||||
State: | PA | ||||||||
PostalCode: | 151463500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4128567500 | ||||||||
FaxNumber: | 4128566079 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/14/2005 | ||||||||
LastUpdateDate: | 12/08/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/08/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | MW010098 | PA | Y |   | Other Service Providers | Midwife |   |
ID Information
ID | Type | State | Issuer | Description | 101339671 | 05 | PA |   | MEDICAID |