Provider Demographics
NPI:1497188452
Name:COLANTUONI, JULIE B (RN, NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:COLANTUONI
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5719
Mailing Address - Country:US
Mailing Address - Phone:401-415-4618
Mailing Address - Fax:401-415-4348
Practice Address - Street 1:1324 BELMONT ST STE 202
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4435
Practice Address - Country:US
Practice Address - Phone:401-415-4618
Practice Address - Fax:401-415-4348
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2275231363L00000X
MA2275231363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care