Provider Demographics
NPI:1942307996
Name:HOMANN, JULIE A (FNP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:HOMANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:KNIFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1455 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5559
Mailing Address - Country:US
Mailing Address - Phone:970-686-3950
Mailing Address - Fax:970-686-3960
Practice Address - Street 1:1455 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5559
Practice Address - Country:US
Practice Address - Phone:970-686-3950
Practice Address - Fax:970-686-3960
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-4968363L00000X, 363LF0000X
CORN-129585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00944652OtherMEDICARE RAILROAD CARRIER PTAN
CO97776262Medicaid
CO97776262Medicaid
COCO307203Medicare PIN
C808238Medicare PIN