Provider Demographics
NPI:1003611690
Name:JULIE PETERS WOUND PRACTITIONER, LLC
Entity type:Organization
Organization Name:JULIE PETERS WOUND PRACTITIONER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:480-734-8261
Mailing Address - Street 1:1525 S HIGLEY RD
Mailing Address - Street 2:STE 104 PMB 2556
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296
Mailing Address - Country:US
Mailing Address - Phone:480-734-8261
Mailing Address - Fax:
Practice Address - Street 1:11 N SOHO PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5721
Practice Address - Country:US
Practice Address - Phone:480-223-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty