Provider Demographics
NPI:1871596353
Name:HANNAH, JULIE A (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:HANNAH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:ULTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1177 ESSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9523
Mailing Address - Country:US
Mailing Address - Phone:678-899-1870
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 1201
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2961
Practice Address - Country:US
Practice Address - Phone:916-780-0110
Practice Address - Fax:916-536-7241
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2802Medicare ID - Type Unspecified