Provider Demographics
NPI:1245758721
Name:GEMBUS, JULI ANNE (BA, MPA, RA)
Entity Type:Individual
Prefix:MRS
First Name:JULI
Middle Name:ANNE
Last Name:GEMBUS
Suffix:
Gender:F
Credentials:BA, MPA, RA
Other - Prefix:
Other - First Name:JULI
Other - Middle Name:ANNE
Other - Last Name:PAMPUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MPA
Mailing Address - Street 1:8445 MUNSON RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2410
Mailing Address - Country:US
Mailing Address - Phone:440-255-1700
Mailing Address - Fax:440-205-2417
Practice Address - Street 1:8445 MUNSON
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-255-1700
Practice Address - Fax:440-205-2417
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2844093Medicaid