Provider Demographics
NPI:1275957466
Name:BORNMANN, JULIA LEE (APN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LEE
Last Name:BORNMANN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:L
Other - Last Name:GRAYDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2301 E EVESHAM RD STE 306
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4503
Mailing Address - Country:US
Mailing Address - Phone:856-554-3822
Mailing Address - Fax:856-281-9913
Practice Address - Street 1:2301 E EVESHAM RD STE 306
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4503
Practice Address - Country:US
Practice Address - Phone:856-554-3822
Practice Address - Fax:856-281-9913
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00482700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0455091OtherGROUP MEDICAID
NJ381020OtherGROUP MEDICARE
NJ381020OtherGROUP MEDICARE
NJ0403555Medicaid