Healthcare Provider Details

I. General information

NPI: 1609904317
Provider Name (Legal Business Name): JULIE ANN PUDIL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 TALLULAH RD
ROBBINSVILLE NC
28771-8500
US

IV. Provider business mailing address

PO BOX 100181
COLUMBIA SC
29202-3141
US

V. Phone/Fax

Practice location:
  • Phone: 828-253-3717
  • Fax: 828-252-8072
Mailing address:
  • Phone: 828-202-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343279
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1625
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF089140
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5018883
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: