Provider Demographics
NPI:1164558219
Name:WARD, JULIE LEA (NP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LEA
Last Name:WARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:LEA
Other - Last Name:KLENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:513 ANACONDA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1602
Mailing Address - Country:US
Mailing Address - Phone:719-406-6057
Mailing Address - Fax:719-266-6111
Practice Address - Street 1:6820 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-5114
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:719-266-6111
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91171288Medicaid
COE8668Medicare ID - Type Unspecified