Healthcare Provider Details

I. General information

NPI: 1871596353
Provider Name (Legal Business Name): JULIE A. HANNAH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE A. ULTSCH FNP-C

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N SUNRISE AVE STE 1201
ROSEVILLE CA
95661-2961
US

IV. Provider business mailing address

1177 ESSINGTON LN
ROSEVILLE CA
95747-9523
US

V. Phone/Fax

Practice location:
  • Phone: 916-780-0110
  • Fax: 916-536-7241
Mailing address:
  • Phone: 678-899-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: