Provider Demographics
NPI:1215023783
Name:DAVIS, JULIE KAY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W. HYNES
Mailing Address - Street 2:
Mailing Address - City:O'NEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763
Mailing Address - Country:US
Mailing Address - Phone:402-336-4096
Mailing Address - Fax:
Practice Address - Street 1:2ND AND ADAMS
Practice Address - Street 2:
Practice Address - City:O'NEILL
Practice Address - State:NE
Practice Address - Zip Code:68763
Practice Address - Country:US
Practice Address - Phone:402-336-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEX599999Medicare UPIN