Healthcare Provider Details

I. General information

NPI: 1154613248
Provider Name (Legal Business Name): JULIE ANN WESP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR STE 240
SANTA FE NM
87505-7691
US

IV. Provider business mailing address

1209 7TH ST APARTMENT 2
HUNTINGTON WV
25701-3217
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3975
  • Fax: 505-986-8001
Mailing address:
  • Phone: 510-393-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2017-0708
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: