Healthcare Provider Details

I. General information

NPI: 1518333772
Provider Name (Legal Business Name): JULIE A HORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 W WACO DR
WACO TX
76710-5345
US

IV. Provider business mailing address

171 INTREPID LN
SYRACUSE NY
13205-2548
US

V. Phone/Fax

Practice location:
  • Phone: 254-307-8607
  • Fax: 254-765-2501
Mailing address:
  • Phone: 315-437-4689
  • Fax: 315-437-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number939209
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: