Provider Demographics
NPI:1679853535
Name:FELIX, JULIE E (APNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:FELIX
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:420 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-745-3590
Mailing Address - Fax:920-745-7899
Practice Address - Street 1:790 EASTGATE DR
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9614
Practice Address - Country:US
Practice Address - Phone:920-945-3590
Practice Address - Fax:920-745-7899
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4525-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679853535Medicaid
WI004160160Medicare PIN
WI1679853535Medicaid