Provider Demographics
NPI:1376701813
Name:WALCUTT, JULIE ELLEN ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELLEN ROSE
Last Name:WALCUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-5600
Mailing Address - Fax:
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE279092085P0229X
MO2013013937208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care