Provider Demographics
NPI:1548322563
Name:MCGHEE, JULIE A (APN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 E SKINNER RD
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084-9230
Mailing Address - Country:US
Mailing Address - Phone:815-985-6740
Mailing Address - Fax:
Practice Address - Street 1:6601 E SKINNER RD
Practice Address - Street 2:
Practice Address - City:STILLMAN VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61084-9230
Practice Address - Country:US
Practice Address - Phone:815-985-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001234363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209001234Medicaid
ILMJ0753839OtherDEA