Provider Demographics
NPI:1790145597
Name:WADHAMS, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WADHAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COUNTRY CLUB CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1219
Mailing Address - Country:US
Mailing Address - Phone:217-799-4989
Mailing Address - Fax:
Practice Address - Street 1:108 COUNTRY CLUB CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1219
Practice Address - Country:US
Practice Address - Phone:217-799-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5005070222471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging