Basic Information
Provider Information
NPI: 1003800814
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAUTSCHE
FirstName: JULIA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: C.N.M.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1111 LIGHTHOUSE LANE
Address2:  
City: GOSHEN
State: IN
PostalCode: 465263824
CountryCode: US
TelephoneNumber: 5745330348
FaxNumber: 5745330277
Practice Location
Address1: 1111 LIGHTHOUSE LANE
Address2:  
City: GOSHEN
State: IN
PostalCode: 465263824
CountryCode: US
TelephoneNumber: 5745330348
FaxNumber: 5745330277
Other Information
ProviderEnumerationDate: 09/07/2005
LastUpdateDate: 09/21/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X72000004INY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

ID Information
IDTypeStateIssuerDescription
20006904005IN MEDICAID


Home