Provider Demographics
NPI:1407211865
Name:SMITH, JULIE ANN (EIS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:EIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7356
Mailing Address - Country:US
Mailing Address - Phone:915-544-8484
Mailing Address - Fax:915-496-0751
Practice Address - Street 1:6545 WIND RIDGE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7356
Practice Address - Country:US
Practice Address - Phone:915-544-8484
Practice Address - Fax:915-496-0751
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96-0266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist