Provider Demographics
NPI:1154668788
Name:LECLAIRE, JULIE M (NP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:M
Last Name:LECLAIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:DEUTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-644-4220
Mailing Address - Fax:970-263-4239
Practice Address - Street 1:2020 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2914
Practice Address - Country:US
Practice Address - Phone:970-644-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0168065163W00000X
COAPN0990953NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61456365Medicaid
CO856741OtherMEDICARE PTAN