Provider Demographics
NPI:1730394016
Name:IMBROGNO, JULIE ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:IMBROGNO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N BEND RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-8658
Mailing Address - Country:US
Mailing Address - Phone:440-998-2522
Mailing Address - Fax:
Practice Address - Street 1:3000 N BEND RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-8658
Practice Address - Country:US
Practice Address - Phone:440-998-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN105112 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse