=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952246845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE CLOUGHERTY RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138 CECIL MALONE DR
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-252-7469
-----------------------------------------------------
Fax | 607-277-1494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 163 YAPLE RD
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-8628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-252-7469
-----------------------------------------------------
Fax | 607-277-1494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 719329-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------