Healthcare Provider Details

I. General information

NPI: 1831135342
Provider Name (Legal Business Name): JULIE ANNE DUBOSE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 RIDGE RD
CLEVELAND OH
44102-5464
US

IV. Provider business mailing address

3545 RIDGE RD
CLEVELAND OH
44102-5464
US

V. Phone/Fax

Practice location:
  • Phone: 216-281-0872
  • Fax: 216-281-9565
Mailing address:
  • Phone: 216-281-0872
  • Fax: 216-281-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM 05812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: