Basic Information
| Provider Information | |||||||||
| NPI: | 1396829198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JULICH | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2412 WILKINS DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273307268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197766000 | ||||||||
| FaxNumber: | 9197761751 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 WILKINS DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273307268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197766000 | ||||||||
| FaxNumber: | 9197761751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 200481 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 080065373 | 01 | NC | RR MEDICARE-PITTSBORO | OTHER | 52925 | 01 | NC | MEDCOST-SANFORD | OTHER | 0151824 | 01 | NC | UNITEDHEALTHCARE-PITTSBOR | OTHER | 25528 | 01 | NC | MEDCOST-PITTSBORO | OTHER | 0151826 | 01 | NC | UNITEDHEALTHCARE-SANFORD | OTHER | 43454 | 01 | NC | BCBS | OTHER | 080152361 | 01 | NC | RR MEDCARE-SANFORD | OTHER | 152734500 | 01 | NC | US DEPT OF LABOR | OTHER | 7003952 | 05 | NC | MEDICAID |