Provider Demographics
NPI:1164826699
Name:PRUIM, JULIE MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:PRUIM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-836-1060
Mailing Address - Fax:219-836-1014
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-836-1060
Practice Address - Fax:219-836-1014
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28140240A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner