Provider Demographics
NPI:1841540358
Name:JULY, JORI ANNE (CNP)
Entity type:Individual
Prefix:
First Name:JORI
Middle Name:ANNE
Last Name:JULY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S SAGINAW ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1525
Mailing Address - Country:US
Mailing Address - Phone:810-237-4538
Mailing Address - Fax:810-742-2561
Practice Address - Street 1:G3373 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1244
Practice Address - Country:US
Practice Address - Phone:810-237-4538
Practice Address - Fax:810-742-2561
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251748363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841540358Medicaid