Basic Information
| Provider Information | |||||||||
| NPI: | 1225462278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480674121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485847600 | ||||||||
| FaxNumber: | 2485847606 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480674121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485847600 | ||||||||
| FaxNumber: | 2485847606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2013 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 4704190813 | MI | Y | Other Service Providers | Midwife |
No ID Information.