Provider Demographics
NPI:1083167019
Name:BASS, JULIE M (RN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BASS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4770 BASELINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2669
Mailing Address - Country:US
Mailing Address - Phone:720-798-4516
Mailing Address - Fax:617-507-1426
Practice Address - Street 1:4770 BASELINE RD STE 300
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2669
Practice Address - Country:US
Practice Address - Phone:720-798-4516
Practice Address - Fax:617-507-1426
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-426786163W00000X
COAPN.0998211-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse