Provider Demographics
NPI:1891094736
Name:BOUIE, JULIE M (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BOUIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:SAXEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:P O BOX 1123
Mailing Address - Street 2:225 W. MICHIGAN AVENUE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-1123
Mailing Address - Country:US
Mailing Address - Phone:800-516-5315
Mailing Address - Fax:517-787-7365
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:800-516-5315
Practice Address - Fax:517-787-7365
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA.12093367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered