Provider Demographics
NPI:1083611727
Name:TREVINO-EMERSON, JULIA BERNADINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:BERNADINE
Last Name:TREVINO-EMERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3095
Mailing Address - Country:US
Mailing Address - Phone:308-352-7200
Mailing Address - Fax:308-352-7290
Practice Address - Street 1:221 E 10TH ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-1425
Practice Address - Country:US
Practice Address - Phone:308-284-8421
Practice Address - Fax:308-284-2821
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01363894Medicaid
CO01363894Medicaid