Provider Demographics
NPI:1285983916
Name:WESTGERDES, JULIE A (BNCB)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WESTGERDES
Suffix:
Gender:
Credentials:BNCB
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:SWAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:830 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:909 E WAYNE ST STE 104
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3304
Practice Address - Country:US
Practice Address - Phone:419-586-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13761363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098028Medicaid
OH0105065OtherGROUP MEDICAID
OH1184652539OtherGROUP NPI - JTDM FAMILY PRACTICE, LLC
OH0098028Medicaid