Provider Demographics
NPI:1184109167
Name:WILEY, JULIE LATHAM
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LATHAM
Last Name:WILEY
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 1:23845 LEE BAKER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3378
Mailing Address - Country:US
Mailing Address - Phone:248-991-5775
Mailing Address - Fax:
Practice Address - Street 1:23845 LEE BAKER DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3378
Practice Address - Country:US
Practice Address - Phone:248-355-2294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home