Provider Demographics
NPI:1558356139
Name:MONDANARO, JULIE MARIE (FNP)
Entity Type:Individual
Prefix:PROF
First Name:JULIE
Middle Name:MARIE
Last Name:MONDANARO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:MONDANARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1004
Mailing Address - Country:US
Mailing Address - Phone:716-878-6711
Mailing Address - Fax:716-878-6727
Practice Address - Street 1:1300 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1004
Practice Address - Country:US
Practice Address - Phone:716-878-6711
Practice Address - Fax:716-878-6727
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily