Provider Demographics
NPI: | 1538497888 |
---|---|
Name: | RIEDEL, JULIE A (FNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | JULIE |
Middle Name: | A |
Last Name: | RIEDEL |
Suffix: | |
Gender: | F |
Credentials: | FNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1113 MURFREESBORO RD |
Mailing Address - Street 2: | SUITE 319 |
Mailing Address - City: | FRANKLIN |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37064-1306 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-790-0567 |
Mailing Address - Fax: | 615-595-8030 |
Practice Address - Street 1: | 1113 MURFREESBORO RD |
Practice Address - Street 2: | SUITE 319 |
Practice Address - City: | FRANKLIN |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37064-1306 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-790-0567 |
Practice Address - Fax: | 615-595-8030 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-11-25 |
Last Update Date: | 2015-12-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 14604 | 363LF0000X |
TN | 59038 | 163W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163W00000X | Nursing Service Providers | Registered Nurse |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 1517612 | Medicaid | |
TN | 4251779 | Other | BCBST |
TN | 1517612 | Medicaid |