Provider Demographics
NPI:1386669752
Name:JOHNG, JULIE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JOHNG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:VAN WYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:611 W FRANCIS ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-0620
Mailing Address - Country:US
Mailing Address - Phone:308-532-3022
Mailing Address - Fax:308-532-5831
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:SUITE 270
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0620
Practice Address - Country:US
Practice Address - Phone:308-532-3022
Practice Address - Fax:308-532-5831
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110678363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ62683Medicare UPIN
NE279808Medicare ID - Type Unspecified