Healthcare Provider Details

I. General information

NPI: 1790143295
Provider Name (Legal Business Name): JULIA L STAIB APRN - NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 CHURCHMAN AVE SUITE 300
LOUISVILLE KY
40215-1190
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-0588
  • Fax: 502-363-0972
Mailing address:
  • Phone: 502-363-0588
  • Fax: 502-363-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009758
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: