Healthcare Provider Details

I. General information

NPI: 1316483738
Provider Name (Legal Business Name): JULIE SHAUN KOZEL WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 10/26/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 E MONMOUTH ST
WINSTON SALEM NC
27107-3227
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-4380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013051
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: