Provider Demographics
NPI:1699207530
Name:SAUER, JULIE (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SAUER
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 1:301 E DAY RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3455
Mailing Address - Country:US
Mailing Address - Phone:574-204-7243
Mailing Address - Fax:574-968-0217
Practice Address - Street 1:301 E DAY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3455
Practice Address - Country:US
Practice Address - Phone:574-204-7243
Practice Address - Fax:745-968-0217
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28201225A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300007324Medicaid