Provider Demographics
NPI:1174549166
Name:MATHENA, JULEE W (NP)
Entity type:Individual
Prefix:
First Name:JULEE
Middle Name:W
Last Name:MATHENA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-364-1001
Mailing Address - Fax:281-364-9095
Practice Address - Street 1:1011 MEDICAL PLAZA DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-364-1001
Practice Address - Fax:281-364-9095
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX456386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S75127Medicare UPIN
TX8B7671Medicare ID - Type Unspecified