Provider Demographics
NPI:1902949357
Name:ROETHLER, JULIE MAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MAY
Last Name:ROETHLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 S WATERFORD CT
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6509
Mailing Address - Country:US
Mailing Address - Phone:608-365-4797
Mailing Address - Fax:
Practice Address - Street 1:1517 E HUEBBE PKWY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1795
Practice Address - Country:US
Practice Address - Phone:608-313-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135690030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse