Provider Demographics
NPI:1497054464
Name:REYNOLDS, JULIE ANN LISA (APNP-BC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN LISA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APNP-BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN LISA
Other - Last Name:EMMERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5337 W GRANDE MARKET DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8442
Mailing Address - Country:US
Mailing Address - Phone:920-731-7445
Mailing Address - Fax:
Practice Address - Street 1:5337 W GRANDE MARKET DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8442
Practice Address - Country:US
Practice Address - Phone:920-731-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135242-30163W00000X
WI7843-33363L00000X
WI7843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner