Provider Demographics
NPI:1861061202
Name:BIRD, JULIE ANNE (RN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:BIRD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2319 MARLENE DR
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-7918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2319 MARLENE DR
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-7918
Practice Address - Country:US
Practice Address - Phone:810-210-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290440163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse