Basic Information
| Provider Information | |||||||||
| NPI: | 1730463597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIGIOVANNI | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N PARK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693822500 | ||||||||
| FaxNumber: | 2693730123 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 N PARK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693848641 | ||||||||
| FaxNumber: | 2693730123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2011 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SX0200X | 5601006079 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1447261730 | 01 | MI | BCBSM WMCC | OTHER | 1730463597 | 05 | MI | MEDICAID |