Provider Demographics
NPI:1043623309
Name:LIENESCH, JULIA
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:LIENESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:MUENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-0267
Mailing Address - Country:US
Mailing Address - Phone:208-413-4032
Mailing Address - Fax:
Practice Address - Street 1:301 CEDAR ST
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9029
Practice Address - Country:US
Practice Address - Phone:208-476-5777
Practice Address - Fax:208-476-5385
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60474280367500000X
IDCRNA61662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered