Provider Demographics
NPI:1922108158
Name:PEW, JULIE A (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:PEW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8074 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3303
Mailing Address - Country:US
Mailing Address - Phone:402-991-9500
Mailing Address - Fax:402-991-9564
Practice Address - Street 1:8074 S 84TH ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3303
Practice Address - Country:US
Practice Address - Phone:402-991-9500
Practice Address - Fax:402-991-9564
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-122465363LF0000X
NE110352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081642113Medicaid
NE24508OtherBCBS
NEN/AOtherCOVENTRY
NEN/AOtherMIDLANDS CHOICE
NEN/AOtherMIDLANDS CHOICE
NE99981005Medicare PIN
NE10025817200Medicaid
NEE09153Medicare UPIN