Healthcare Provider Details

I. General information

NPI: 1992642417
Provider Name (Legal Business Name): JULIE ANN MOHLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17172 W COTTONWOOD ST
SURPRISE AZ
85388-1203
US

IV. Provider business mailing address

17172 W COTTONWOOD ST
SURPRISE AZ
85388-1203
US

V. Phone/Fax

Practice location:
  • Phone: 623-760-6700
  • Fax:
Mailing address:
  • Phone: 623-760-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number4201467
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: