Provider Demographics
NPI:1407387442
Name:KIEFFER, JULIA ANNETTE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNETTE
Last Name:KIEFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N 16TH ST # 120-228
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5512
Mailing Address - Country:US
Mailing Address - Phone:480-410-4128
Mailing Address - Fax:480-480-4130
Practice Address - Street 1:1492 S MILL AVE STE 212
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5664
Practice Address - Country:US
Practice Address - Phone:480-410-4128
Practice Address - Fax:480-410-4130
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10404363L00000X, 363LF0000X
AZRN113054163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency