Provider Demographics
NPI:1811230352
Name:LASSIG, JULIE ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:LASSIG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 S MAIN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2090
Mailing Address - Country:US
Mailing Address - Phone:801-657-5580
Mailing Address - Fax:801-401-7876
Practice Address - Street 1:99 NORTH WEST END BOULEVARD
Practice Address - Street 2:SUITE 102
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1272
Practice Address - Country:US
Practice Address - Phone:215-538-0202
Practice Address - Fax:215-538-9580
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN589483163W00000X
PASP012890363LF0000X
UT8317626-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse