Provider Demographics
NPI:1568852978
Name:MASTROE, JULIANNE (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:MASTROE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:MISS
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:KULEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:97 BARNES RD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1885
Mailing Address - Country:US
Mailing Address - Phone:203-265-9890
Mailing Address - Fax:203-265-3321
Practice Address - Street 1:97 BARNES RD.
Practice Address - Street 2:SUITE 6
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1885
Practice Address - Country:US
Practice Address - Phone:203-265-9890
Practice Address - Fax:203-265-3321
Is Sole Proprietor?:No
Enumeration Date:2015-01-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9981363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008089895Medicaid