Provider Demographics
NPI:1740041573
Name:GAUNTNER, JULIE MARIE (MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:GAUNTNER
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6803 MAYFIELD RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-477-0174
Mailing Address - Fax:
Practice Address - Street 1:6803 MAYFIELD RD BLDG 1
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-312-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035884363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health