Provider Demographics
NPI:1104812635
Name:RESHESKE, JULIE LORRAINE (CPNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LORRAINE
Last Name:RESHESKE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LORRAINE
Other - Last Name:RESHESKE-FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2033 CONCHA LOOP
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-1266
Mailing Address - Country:US
Mailing Address - Phone:307-638-8975
Mailing Address - Fax:307-634-9267
Practice Address - Street 1:1551 BRICE ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3505
Practice Address - Country:US
Practice Address - Phone:307-322-3861
Practice Address - Fax:307-322-2018
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT463169703102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN