Provider Demographics
NPI:1588754634
Name:WOOTEN, JULIE M (FNP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:M
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:40 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6008
Practice Address - Country:US
Practice Address - Phone:831-724-7525
Practice Address - Fax:831-724-7438
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CARN 583685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ28513ZMedicare ID - Type Unspecified
Q09655Medicare UPIN