Healthcare Provider Details

I. General information

NPI: 1386669752
Provider Name (Legal Business Name): JULIE ANN JOHNG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANN VAN WYKE APRN

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W FRANCIS ST SUITE 270
NORTH PLATTE NE
69101-0620
US

IV. Provider business mailing address

611 W FRANCIS ST SUITE 270
NORTH PLATTE NE
69101-0620
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-3022
  • Fax: 308-532-5831
Mailing address:
  • Phone: 308-532-3022
  • Fax: 308-532-5831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number110678
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: