Provider Demographics
NPI:1720491301
Name:DALE, JULIE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:DALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 ZUMBEHL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2723
Mailing Address - Country:US
Mailing Address - Phone:636-206-2690
Mailing Address - Fax:636-206-2691
Practice Address - Street 1:2031 ZUMBEHL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2723
Practice Address - Country:US
Practice Address - Phone:636-206-2690
Practice Address - Fax:636-206-2691
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014017978363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care