Provider Demographics
NPI:1982696795
Name:DANCE, JULIE ANN (CNFP, CNM)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:DANCE
Suffix:
Gender:F
Credentials:CNFP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W 24TH ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8366
Mailing Address - Country:US
Mailing Address - Phone:928-726-5101
Mailing Address - Fax:928-726-5031
Practice Address - Street 1:1025 W 24TH ST
Practice Address - Street 2:SUITE 28
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8366
Practice Address - Country:US
Practice Address - Phone:928-726-5101
Practice Address - Fax:928-726-5031
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN067452367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813908Medicaid
AZAZ0146620OtherBLUE CROSS/BLUE SHIELD
AZ813908Medicaid
AZAZ0146620OtherBLUE CROSS/BLUE SHIELD