Individual
JULIE ANN VANMATRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-8858
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71000332A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000292416
ANTHEM PROVIDER NUMBER
IN
05
—
200119450
—
IN
01
—
9397708
PHCS PID NUMBER
IN
Enumeration date
03/23/2006
Last updated
03/01/2021
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