Provider Demographics
NPI:1750090445
Name:LAUSE, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LAUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23664 BAYS RD
Mailing Address - Street 2:
Mailing Address - City:CUSTAR
Mailing Address - State:OH
Mailing Address - Zip Code:43511-9770
Mailing Address - Country:US
Mailing Address - Phone:419-601-3319
Mailing Address - Fax:
Practice Address - Street 1:23664 BAYS RD
Practice Address - Street 2:
Practice Address - City:CUSTAR
Practice Address - State:OH
Practice Address - Zip Code:43511-9770
Practice Address - Country:US
Practice Address - Phone:419-601-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care