Provider Demographics
NPI:1063912251
Name:FRY, JULIE MICHELLE (LVN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MICHELLE
Last Name:FRY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 OAK HVN E
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4985
Mailing Address - Country:US
Mailing Address - Phone:281-788-6606
Mailing Address - Fax:
Practice Address - Street 1:210 FORESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-2032
Practice Address - Country:US
Practice Address - Phone:832-290-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315733164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse