Healthcare Provider Details

I. General information

NPI: 1912149691
Provider Name (Legal Business Name): JULIE NICOLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 TULARE ST
FRESNO CA
93721-1415
US

IV. Provider business mailing address

3032 TULARE ST
FRESNO CA
93721-1415
US

V. Phone/Fax

Practice location:
  • Phone: 559-889-3246
  • Fax: 559-422-6151
Mailing address:
  • Phone: 559-889-3246
  • Fax: 559-422-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA123758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: