MEDICARE: MS. JULIE ANNE SWEENY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704120493	MI

General Provider Information

NPI Number	:	1780099275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE ANNE SWEENY

Provider Business Mailing Address
First Line	:	2211 FORT ST
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-4135
Country	:	US
Telephone Number	:	734-246-5705
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 FORT ST
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-4135
Country	:	US
Telephone Number	:	734-246-5705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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