Provider Demographics
NPI:1477731735
Name:DANIELS, JULIE LYN (CNM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:130 KATE IRELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749
Mailing Address - Country:US
Mailing Address - Phone:606-672-2901
Mailing Address - Fax:606-672-2851
Practice Address - Street 1:130 KATE IRELAND DRIVE
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749
Practice Address - Country:US
Practice Address - Phone:606-672-2901
Practice Address - Fax:606-672-2851
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704172420176B00000X
KY6041M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F318190OtherBCBSM
MI0F34985Medicare PIN