Provider Demographics
NPI:1780712083
Name:HAFENDORFER, JULIE (RN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:HAFENDORFER
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 1:10101 LINN STATION RD
Mailing Address - Street 2:SUITE 560
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3848
Mailing Address - Country:US
Mailing Address - Phone:502-412-3253
Mailing Address - Fax:502-412-3202
Practice Address - Street 1:10101 LINN STATION RD
Practice Address - Street 2:SUITE 560
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3848
Practice Address - Country:US
Practice Address - Phone:502-412-3253
Practice Address - Fax:502-412-3202
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1069791163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse