Provider Demographics
NPI:1871645994
Name:DVERSDALL, JULIE ELIZABETH (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELIZABETH
Last Name:DVERSDALL
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1003
Mailing Address - Country:US
Mailing Address - Phone:513-367-5888
Mailing Address - Fax:513-367-1015
Practice Address - Street 1:2515 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1003
Practice Address - Country:US
Practice Address - Phone:513-367-5888
Practice Address - Fax:513-367-1015
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09824-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics