Provider Demographics
NPI:1427005545
Name:NEVILLE, JULIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:GRUNDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 WESTERN HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3446
Mailing Address - Country:US
Mailing Address - Phone:307-635-0226
Mailing Address - Fax:307-635-1924
Practice Address - Street 1:123 WESTERN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3446
Practice Address - Country:US
Practice Address - Phone:307-635-0226
Practice Address - Fax:307-635-1924
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040018207N00000X
WY7675A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I55582Medicare UPIN