Provider Demographics
NPI:1235278193
Name:BARTELS-HISCOCK, JULIE J
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:J
Last Name:BARTELS-HISCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N 118TH CIR STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3862
Mailing Address - Country:US
Mailing Address - Phone:402-934-9711
Mailing Address - Fax:
Practice Address - Street 1:2920 N 118TH CIR STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3862
Practice Address - Country:US
Practice Address - Phone:402-934-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEF247453OtherMIDLANDS CHOICE
NE02041OtherBLUE CROSS BLUE SHIELD
NE6400524OtherUNITED HEALTHCARE
IA0593756Medicaid
NE02041OtherBLUE CROSS BLUE SHIELD
IA0593756Medicaid
NE6400524OtherUNITED HEALTHCARE