Provider Demographics
NPI:1245268788
Name:WAITE, JULIE D (ARNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:WAITE
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 N 103RD AVE STE 59
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3056
Mailing Address - Country:US
Mailing Address - Phone:623-594-4126
Mailing Address - Fax:623-594-4127
Practice Address - Street 1:2501 N STOCKTON HILL RD STE 108
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4140
Practice Address - Country:US
Practice Address - Phone:928-255-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ289530363LF0000X, 363LF0000X
WAAP30005954363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB25294Medicare ID - Type Unspecified
WAP44273Medicare UPIN
P44273Medicare UPIN