Healthcare Provider Details

I. General information

NPI: 1669170403
Provider Name (Legal Business Name): JULIE ANN WRATHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41194 PROMENADE CHARDONNAY HLS
TEMECULA CA
92591-4986
US

IV. Provider business mailing address

1510 N SANTA FE AVE
VISTA CA
92083-2001
US

V. Phone/Fax

Practice location:
  • Phone: 951-440-2034
  • Fax:
Mailing address:
  • Phone: 760-724-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number523145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: