Provider Demographics
NPI:1811212111
Name:JEROME, JULIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:JEROME
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 1:1020 GRAND PRIX DRIVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1922
Mailing Address - Country:US
Mailing Address - Phone:209-572-4559
Mailing Address - Fax:
Practice Address - Street 1:2407 WEST VINE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3730
Practice Address - Country:US
Practice Address - Phone:209-334-1614
Practice Address - Fax:209-334-0115
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily