Provider Demographics
NPI:1235371238
Name:BRACKEN, JULIE E (RN, MS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 W 99TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3641
Mailing Address - Country:US
Mailing Address - Phone:708-636-3156
Mailing Address - Fax:
Practice Address - Street 1:2616 W 99TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3641
Practice Address - Country:US
Practice Address - Phone:708-636-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041176100163WE0003X
IL209000130364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WE0003XNursing Service ProvidersRegistered NurseEmergency