Provider Demographics
NPI:1326441833
Name:WEISS, JULIE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 FOSTER WINTER DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3707
Mailing Address - Country:US
Mailing Address - Phone:248-229-4690
Mailing Address - Fax:
Practice Address - Street 1:22301 FOSTER WINTER DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3707
Practice Address - Country:US
Practice Address - Phone:248-552-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284608363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner