Provider Demographics
NPI:1851363766
Name:MESNIKOFF, JULIA GRAHAM (MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:GRAHAM
Last Name:MESNIKOFF
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE 190
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8731
Mailing Address - Country:US
Mailing Address - Phone:719-955-6000
Mailing Address - Fax:719-955-9595
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 190
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-955-6000
Practice Address - Fax:719-955-9595
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO168456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97830089Medicaid
Q09505Medicare UPIN
CO97830089Medicaid