Provider Demographics
NPI:1780650739
Name:MALEY, JULIE A (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:MALEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:KYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3981
Mailing Address - Country:US
Mailing Address - Phone:217-366-1237
Mailing Address - Fax:
Practice Address - Street 1:3101 FIELDS SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3743
Practice Address - Country:US
Practice Address - Phone:217-366-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000524363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131595OtherHEALTHLINK
IL005832071OtherBLUE CROSS BLUE SHIELD
IL5574560001OtherMEDICARE DME
ILP00273354OtherRAILROAD MEDICARE
ILP00273354OtherRAILROAD MEDICARE
IL131595OtherHEALTHLINK