Provider Demographics
NPI:1023388279
Name:SHUTE, JULIE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:SHUTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 E TRIGGER WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1109
Mailing Address - Country:US
Mailing Address - Phone:480-229-4630
Mailing Address - Fax:
Practice Address - Street 1:2086 E TRIGGER WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1109
Practice Address - Country:US
Practice Address - Phone:480-123-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10001363LF0000X
WAAP61139079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily