Healthcare Provider Details

I. General information

NPI: 1689618316
Provider Name (Legal Business Name): JULIE ANN HARSTINE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 PROVIDENT DRIVE STE A
WARSAW IN
46580
US

IV. Provider business mailing address

1500 PROVIDENT DR SUITE A
WARSAW IN
46580-3291
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-8383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28119598A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: