Healthcare Provider Details

I. General information

NPI: 1083611727
Provider Name (Legal Business Name): JULIA BERNADINE TREVINO-EMERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 10TH ST
OGALLALA NE
69153-1425
US

IV. Provider business mailing address

900 LINCOLN AVE
GRANT NE
69140-3095
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-8421
  • Fax: 308-284-2821
Mailing address:
  • Phone: 308-352-7200
  • Fax: 308-352-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31731
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: