Provider Demographics
NPI:1477598548
Name:GORENC, JULIE A (CNM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GORENC
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-1414
Mailing Address - Country:US
Mailing Address - Phone:913-544-2560
Mailing Address - Fax:888-796-4551
Practice Address - Street 1:9710 ROSEHILL RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215
Practice Address - Country:US
Practice Address - Phone:913-544-2560
Practice Address - Fax:888-796-4551
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
KS64055367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100393690AMedicaid
MOY36000026Medicare PIN
KSA22A871Medicare ID - Type Unspecified
KS100393690AMedicaid