Healthcare Provider Details

I. General information

NPI: 1891985255
Provider Name (Legal Business Name): JULIE OMAR MEASE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE OMAR

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 DUTCHMANS LN SUITE 601
LOUISVILLE KY
40207
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-423-9595
  • Fax: 502-719-0161
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41326189
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0000640
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3009747
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: