Provider Demographics
NPI:1992947550
Name:WELLER, JULIE M (CNP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:M
Last Name:WELLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 N MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2328
Mailing Address - Country:US
Mailing Address - Phone:937-280-4988
Mailing Address - Fax:937-280-4994
Practice Address - Street 1:7980 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2328
Practice Address - Country:US
Practice Address - Phone:937-280-4988
Practice Address - Fax:937-280-4994
Is Sole Proprietor?:No
Enumeration Date:2009-03-28
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10625-NP363LA2100X
OHRS648303363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care