Provider Demographics
NPI:1902211683
Name:WEIST, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WEIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 E WHITTAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1145
Mailing Address - Country:US
Mailing Address - Phone:414-243-4174
Mailing Address - Fax:
Practice Address - Street 1:3511 E WHITTAKER AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1145
Practice Address - Country:US
Practice Address - Phone:414-243-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148422-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse