Provider Demographics
NPI:1356611578
Name:MASSENGALE, JULIE (RN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MASSENGALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3528
Mailing Address - Country:US
Mailing Address - Phone:785-242-4242
Mailing Address - Fax:785-242-7885
Practice Address - Street 1:1401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3528
Practice Address - Country:US
Practice Address - Phone:785-242-4242
Practice Address - Fax:785-242-7885
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-92866-081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse