Healthcare Provider Details

I. General information

NPI: 1952246845
Provider Name (Legal Business Name): JULIE CLOUGHERTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 CECIL MALONE DR
ITHACA NY
14850-5124
US

IV. Provider business mailing address

163 YAPLE RD
ITHACA NY
14850-8628
US

V. Phone/Fax

Practice location:
  • Phone: 607-252-7469
  • Fax: 607-277-1494
Mailing address:
  • Phone: 607-252-7469
  • Fax: 607-277-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number719329-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: