Provider Demographics
NPI:1235395112
Name:LA MAIDE, JULIA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:M
Last Name:LA MAIDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N919 PEBBLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8672
Mailing Address - Country:US
Mailing Address - Phone:920-757-5746
Mailing Address - Fax:
Practice Address - Street 1:N919 PEBBLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-8672
Practice Address - Country:US
Practice Address - Phone:920-757-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116716-030163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice