Healthcare Provider Details

I. General information

NPI: 1134362122
Provider Name (Legal Business Name): JULIE MCCRAY KLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 CHANATE RD
SANTA ROSA CA
95404-1710
US

IV. Provider business mailing address

3420 CHANATE ROAD
SANTA ROSA CA
95404
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4793
  • Fax:
Mailing address:
  • Phone: 707-565-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number205622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: