Provider Demographics
NPI:1710549142
Name:ROBERTS, JULIE (DHA)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18993 STONEBLUFF LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6154
Mailing Address - Country:US
Mailing Address - Phone:317-922-6407
Mailing Address - Fax:
Practice Address - Street 1:18993 STONEBLUFF LN
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-6154
Practice Address - Country:US
Practice Address - Phone:317-922-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1901462113747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN833544842Medicaid