Basic Information
| Provider Information | |||||||||
| NPI: | 1669473948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENNE-REESE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.R.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7580 BUCKINGHAM BLVD STE 220 | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210763210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 125 SHOREWAY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | QUEENSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216581666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108274001 | ||||||||
| FaxNumber: | 4108274333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 08/22/2019 | ||||||||
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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 | 363LF0000X | R130914 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 500027792 | 01 | MD | RR MEDICARE | OTHER | 369040700 | 05 | MD | MEDICAID | 7605-0052 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 9326221 | 01 | MD | AETNA PPO | OTHER | 100168 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 1970965 | 01 | MD | AETNA HMO | OTHER | 615790-02 | 01 | MD | CAREFIRST MD RENDERING | OTHER |