Provider Demographics
NPI:1831135342
Name:DUBOSE, JULIE ANNE (CNM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5464
Mailing Address - Country:US
Mailing Address - Phone:216-281-0872
Mailing Address - Fax:216-281-9565
Practice Address - Street 1:3545 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-5464
Practice Address - Country:US
Practice Address - Phone:216-281-0872
Practice Address - Fax:216-281-9565
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM 05812367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2332578Medicaid
OHQ17706Medicare UPIN
OHKENM02971Medicare ID - Type Unspecified