Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 046400-23 | NH |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP9831 | AZ |
NPI | 1407132665 |
---|---|
Provider Name | Ms. Julie Carmen Moreau |
First Address | Tucson, AZ 85705-2101 |
Second Address | Lebanon, NH 03756-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2011 |
Last Update Date | 21/12/2017 |