Provider Demographics
NPI:1629416623
Name:ANDERSON, JULIE (ND)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-2005
Mailing Address - Country:US
Mailing Address - Phone:269-808-6897
Mailing Address - Fax:
Practice Address - Street 1:5053 SPORTS DR
Practice Address - Street 2:SUITE #120
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7117
Practice Address - Country:US
Practice Address - Phone:269-375-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0082437175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath