Provider Demographics
NPI:1508985409
Name:EBBING-LINES, JULIE (CNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:EBBING-LINES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:EBBING-MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:44038 WOODWARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5037
Mailing Address - Country:US
Mailing Address - Phone:248-335-1064
Mailing Address - Fax:
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner