Provider Demographics
NPI:1225098338
Name:DEARMITT, JULIE ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:DEARMITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 W RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-5151
Mailing Address - Country:US
Mailing Address - Phone:608-758-0604
Mailing Address - Fax:
Practice Address - Street 1:1608 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-9603
Practice Address - Country:US
Practice Address - Phone:608-423-3489
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3960670770Medicaid