Healthcare Provider Details

I. General information

NPI: 1720241193
Provider Name (Legal Business Name): JULIE ANN PRIEBE M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST RHODEBUSH VA MEDICAL CENTER
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

1481 W 10TH ST RHODEBUSH VA MEDICAL CENTER
INDIANAPOLIS IN
46202-2803
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-3097
  • Fax: 317-988-4812
Mailing address:
  • Phone: 317-988-3097
  • Fax: 317-988-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number03555325
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: