Provider Demographics
NPI:1174645915
Name:FINE, JULIA M (FNP, PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:M
Last Name:FINE
Suffix:
Gender:F
Credentials:FNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-0393
Mailing Address - Country:US
Mailing Address - Phone:765-653-6171
Mailing Address - Fax:765-653-6171
Practice Address - Street 1:911 W HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1119
Practice Address - Country:US
Practice Address - Phone:812-829-0303
Practice Address - Fax:812-829-0303
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002255A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200841090Medicaid
IN854700GGGGMedicare PIN
IN200841090Medicaid
IN232230MMMMedicare UPIN
IN941090A22Medicare PIN
IN130910KKMedicare PIN