Provider Demographics
NPI:1366743114
Name:PRIEBOY, JULIE ANN (CFNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:PRIEBOY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:GRUBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 E 89TH AVE
Mailing Address - Street 2:2A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7318
Mailing Address - Country:US
Mailing Address - Phone:219-736-2800
Mailing Address - Fax:219-738-3707
Practice Address - Street 1:200 E 89TH AVE
Practice Address - Street 2:2A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7318
Practice Address - Country:US
Practice Address - Phone:219-736-2800
Practice Address - Fax:219-738-3707
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28096366A364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology