MEDICARE: JULIE LYNN ENZWEILER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	APS.005492	OH

General Provider Information

NPI Number	:	1043045487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LYNN ENZWEILER

Provider Business Mailing Address
First Line	:	9 FERNWOOD CT
Second Line	:
City	:	ALEXANDRIA
State	:	KY
Zip	:	41001-1362
Country	:	US
Telephone Number	:	513-510-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 FERNWOOD CT
Second Line	:
City	:	ALEXANDRIA
State	:	KY
Zip	:	41001-1362
Country	:	US
Telephone Number	:	513-510-0214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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Directions to “ JULIE LYNN ENZWEILER ” Practice Location

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