MEDICARE: JULIE FAWAZ

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	363LN0000X	Neonatal Nurse Practitioner	4704359435	MI

General Provider Information

NPI Number	:	1902776495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE FAWAZ

Provider Business Mailing Address
First Line	:	4212 WEATHERWOOD DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-9793
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2345
Country	:	US
Telephone Number	:	231-935-5000
Fax Number	:

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	12/18/2025

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Directions to “ JULIE FAWAZ ” Practice Location

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