Provider Demographics
NPI:1386672178
Name:STALLING, JULIE ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:STALLING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 TOWNSHIP ROAD 197 NE
Mailing Address - Street 2:
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-9526
Mailing Address - Country:US
Mailing Address - Phone:740-342-4290
Mailing Address - Fax:
Practice Address - Street 1:2094 TOWNSHIP ROAD 197 NE
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-9526
Practice Address - Country:US
Practice Address - Phone:740-342-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN097381164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2228048Medicaid
OH2228048Medicaid