Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 101.0086663 | VT |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 101.0886663 | VT |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3336954405 | UT |
NPI | 1003886599 |
---|---|
Provider Name | Julia Mcdougal Ronconi |
First Address | Brattleboro, VT 05301-6295 |
Second Address | Brattleboro, VT 05301-7040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 12/10/2018 |