Provider Demographics
NPI:1750705026
Name:MOMINEE, JULIA ANN (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ANN
Last Name:MOMINEE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S RAISINVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9047
Mailing Address - Country:US
Mailing Address - Phone:734-242-5799
Mailing Address - Fax:734-242-9997
Practice Address - Street 1:1101 S RAISINVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9047
Practice Address - Country:US
Practice Address - Phone:734-242-5799
Practice Address - Fax:734-242-9997
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240828163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool