Provider Demographics
NPI:1932376613
Name:MADARIS, JULIE ANN
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:MADARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:MADARIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:724 159TH ST
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-5012
Mailing Address - Country:US
Mailing Address - Phone:715-796-2905
Mailing Address - Fax:
Practice Address - Street 1:724 159TH ST
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-5012
Practice Address - Country:US
Practice Address - Phone:715-796-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI118005 -030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39946000Medicaid