Provider Demographics
NPI:1497034680
Name:MIRISE, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MIRISE
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 1:1505 E BROWNING LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9400
Mailing Address - Country:US
Mailing Address - Phone:219-789-3499
Mailing Address - Fax:
Practice Address - Street 1:1505 E BROWNING LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-9400
Practice Address - Country:US
Practice Address - Phone:219-789-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula