Provider Demographics
NPI:1447879010
Name:KEWANYAMA, JULIE RENEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RENEE
Last Name:KEWANYAMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:RENEE
Other - Last Name:PLANETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:880 RYLAND ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1603
Mailing Address - Country:US
Mailing Address - Phone:775-329-4600
Mailing Address - Fax:
Practice Address - Street 1:1385 VISTA LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4643
Practice Address - Country:US
Practice Address - Phone:775-329-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN49194163WG0100X
NV831638363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology