Provider Demographics
NPI:1841669629
Name:GARRISON, JULIE ANNE
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45096 190 AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:NE
Mailing Address - Zip Code:68631-4007
Mailing Address - Country:US
Mailing Address - Phone:402-860-9695
Mailing Address - Fax:
Practice Address - Street 1:45096 190 AVE
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:NE
Practice Address - Zip Code:68631-4007
Practice Address - Country:US
Practice Address - Phone:402-860-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4723572842251300000X
NE5-0765910251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)