Active NPI
Diane Elizabeth Juillard, DO
- Family Medicine Physician
- Wickenburg, AZ
National Provider Identifier
1861459224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2240
- Practice address
- 490 W Bralliar Rd
Wickenburg, AZ 85390-2448 - Phone
- (928) 684-2874
- Fax
- (928) 684-3151
- NPI assigned
- Apr 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2240 | AZ | Primary |
Addresses
Primary practice location
490 W Bralliar Rd
Wickenburg, AZ 85390-2448
Mailing address
PO Box 2479
Wickenburg, AZ 85358-2479
Phone (928) 684-2874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050929000930 | AZ | Practitioner - Family Practice | 0345275111 | Practice locations: Wickenburg, AZ |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2240 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1861459224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2479",
"city": "WICKENBURG",
"state": "AZ",
"postal_code": "853582479",
"telephone_number": "928-684-2874",
"fax_number": "928-684-3151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "490 W BRALLIAR RD",
"city": "WICKENBURG",
"state": "AZ",
"postal_code": "853902448",
"telephone_number": "928-684-2874",
"fax_number": "928-684-3151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUILLARD",
"first_name": "DIANE",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-28",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "2240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wickenburg, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.