Provider Demographics
NPI:1104053156
Name:LEUCK, JULIANNE J (APNP)
Entity type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:J
Last Name:LEUCK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6675 BUSINESS PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6349
Mailing Address - Country:US
Mailing Address - Phone:866-799-5886
Mailing Address - Fax:
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-0231
Practice Address - Fax:414-805-2934
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3806-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104053156Medicaid