Provider Demographics
NPI:1225462278
Name:HANSEN, JULIE A (CNM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4121
Mailing Address - Country:US
Mailing Address - Phone:248-584-7600
Mailing Address - Fax:248-584-7606
Practice Address - Street 1:326 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-4121
Practice Address - Country:US
Practice Address - Phone:248-584-7600
Practice Address - Fax:248-584-7606
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190813176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife