Provider Demographics
NPI:1013390491
Name:BUESSER, JULIA FIRLIT
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:FIRLIT
Last Name:BUESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ANNE
Other - Last Name:FIRLIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:3 S GREENLEAF ST
Mailing Address - Street 2:STE J
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3377
Mailing Address - Country:US
Mailing Address - Phone:847-599-1111
Mailing Address - Fax:
Practice Address - Street 1:3 S GREENLEAF ST
Practice Address - Street 2:STE J
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3377
Practice Address - Country:US
Practice Address - Phone:847-599-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012894363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01797137Medicare PIN
F400307882Medicare PIN
F400307881Medicare PIN