Provider Demographics
NPI:1063466191
Name:AVERBECK, JULIE ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:JULIE ANN
Middle Name:
Last Name:AVERBECK
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 1:4855 S MOORLAND RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7494
Mailing Address - Country:US
Mailing Address - Phone:414-425-5660
Mailing Address - Fax:414-425-9803
Practice Address - Street 1:4855 S MOORLAND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7494
Practice Address - Country:US
Practice Address - Phone:414-425-5660
Practice Address - Fax:414-425-9803
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86080-030363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43950200Medicaid
009006261AOtherHUMANA
009006261AOtherHUMANA
P41775Medicare UPIN