Provider Demographics
NPI:1790083350
Name:NOWOTNY, JULIE KAY (RRT, AEC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:NOWOTNY
Suffix:
Gender:F
Credentials:RRT, AEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-5203
Mailing Address - Country:US
Mailing Address - Phone:505-832-4286
Mailing Address - Fax:
Practice Address - Street 1:33 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035-5203
Practice Address - Country:US
Practice Address - Phone:505-832-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2301227900000X
NM32272279E1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational