Provider Demographics
NPI:1093862146
Name:WUBS, JULIE ANN (RN, ACNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:WUBS
Suffix:
Gender:F
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ACNP
Mailing Address - Street 1:900 W IL ROUTE 22 STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3416
Mailing Address - Country:US
Mailing Address - Phone:847-462-1700
Mailing Address - Fax:
Practice Address - Street 1:900 W IL ROUTE 22 STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3416
Practice Address - Country:US
Practice Address - Phone:847-462-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704134021363LA2100X
IL209000480363L00000X
CONP990313363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S92683Medicare UPIN
COCOAAA3296Medicare PIN