Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209-001827 | IL |
N | 363LN0000X | Nurse Practitioner - Neonatal | 2002008638 | MO |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2002008638 | MO |
NPI | 1295955193 |
---|---|
Provider Name | Julie Rae Wetmore |
First Address | Urbana, IL 61803-6004 |
Second Address | Urbana, IL 61801-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 16/04/2013 |