Provider Demographics
NPI:1174824718
Name:TAN, JULIE D (MSN, NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:TAN
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:D
Other - Last Name:STORM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP
Mailing Address - Street 1:2122 E MEYER BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1183
Mailing Address - Country:US
Mailing Address - Phone:816-276-9221
Mailing Address - Fax:866-307-6291
Practice Address - Street 1:9229 WARD PKWY STE 380
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5471
Practice Address - Country:US
Practice Address - Phone:816-319-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner