Provider Demographics
NPI:1578869863
Name:RHEINHEIMER, JULIE ANN (MSN FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:RHEINHEIMER
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:BRANDENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2310 CALIFORNIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1228
Mailing Address - Country:US
Mailing Address - Phone:574-264-0791
Mailing Address - Fax:
Practice Address - Street 1:2310 CALIFORNIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1228
Practice Address - Country:US
Practice Address - Phone:574-264-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28162100A163WE0003X
IN71003529A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201009950Medicaid
IN201009950Medicaid