Provider Demographics
NPI:1689627986
Name:VUKUSICH, JULIE ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:VUKUSICH
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 1:303 N CLAYBERG ST
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:MI
Mailing Address - Zip Code:49911-1122
Mailing Address - Country:US
Mailing Address - Phone:906-663-4273
Mailing Address - Fax:
Practice Address - Street 1:6604 WEST HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451
Practice Address - Country:US
Practice Address - Phone:715-748-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156153-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38327800Medicaid