Healthcare Provider Details

I. General information

NPI: 1043623309
Provider Name (Legal Business Name): MRS. JULIA LIENESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA MUENCH CRNA

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CEDAR ST
OROFINO ID
83544-9029
US

IV. Provider business mailing address

PO BOX 267
GRANGEVILLE ID
83530-0267
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-5777
  • Fax: 208-476-5385
Mailing address:
  • Phone: 208-413-4032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60474280
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA61662
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: