Provider Demographics
NPI:1952488678
Name:MAIKRANZ, JULIE M (LMPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MAIKRANZ
Suffix:
Gender:F
Credentials:LMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 S 70TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4276
Mailing Address - Country:US
Mailing Address - Phone:402-483-1936
Mailing Address - Fax:402-483-7314
Practice Address - Street 1:4501 S 70TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4276
Practice Address - Country:US
Practice Address - Phone:402-483-1936
Practice Address - Fax:402-483-7314
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2811103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080115226Medicaid