Healthcare Provider Details

I. General information

NPI: 1003469487
Provider Name (Legal Business Name): JULIA GUEST ZEAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 NE DIVISION ST
MYRTLE CREEK OR
97457-8507
US

IV. Provider business mailing address

2504 NW MEDICAL PARK DR
ROSEBURG OR
97471-5510
US

V. Phone/Fax

Practice location:
  • Phone: 844-311-5548
  • Fax:
Mailing address:
  • Phone: 317-750-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201905046NP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: