Healthcare Provider Details

I. General information

NPI: 1891124244
Provider Name (Legal Business Name): JULIE MARIE MOZDZEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 S VAN DYKE RD
BAD AXE MI
48413-9615
US

IV. Provider business mailing address

1108 S VAN DYKE RD
BAD AXE MI
48413-9615
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9293
  • Fax: 989-269-3942
Mailing address:
  • Phone: 989-269-9293
  • Fax: 989-269-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704267750
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: