Provider Demographics
NPI:1003886599
Name:MCDOUGAL RONCONI, JULIA (APRN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MCDOUGAL RONCONI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GUILFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6295
Mailing Address - Country:US
Mailing Address - Phone:802-380-1971
Mailing Address - Fax:802-419-3844
Practice Address - Street 1:130 AUSTINE DR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7040
Practice Address - Country:US
Practice Address - Phone:802-380-1971
Practice Address - Fax:802-419-3844
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3336954405363LP0808X
MARN2295461364SP0809X
VT101.0086663363LP0808X
VT101.0886663363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400189391Medicare PIN