Provider Demographics
NPI:1295253490
Name:PASTON, JULIE ANNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNE
Last Name:PASTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1948
Mailing Address - Country:US
Mailing Address - Phone:574-307-7685
Mailing Address - Fax:574-307-7692
Practice Address - Street 1:420 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1948
Practice Address - Country:US
Practice Address - Phone:574-307-7685
Practice Address - Fax:574-307-7692
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007447A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300069384Medicaid
IN236040469OtherMEDICARE