Provider Demographics
NPI:1508530239
Name:PELLMAN, JULIE ANNE (RN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:PELLMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20860 ISHERWOOD TER APT 301
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7789
Mailing Address - Country:US
Mailing Address - Phone:703-855-2025
Mailing Address - Fax:
Practice Address - Street 1:2000 TRIDENT WAY BLDG 624
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5599
Practice Address - Country:US
Practice Address - Phone:559-381-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001192808163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management