=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356717474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ANN WILLEY CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2015
-----------------------------------------------------
Last Update Date | 02/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4820 UNIVERSITY DR NW STE 19
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35816-1867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-429-9441
-----------------------------------------------------
Fax | 256-721-0069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4820 UNIVERSITY DR NW STE 19
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35816-1867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-429-9441
-----------------------------------------------------
Fax | 256-721-0069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-131325
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------