Provider Demographics
NPI:1619236502
Name:PUTT, JULIE OWEN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:OWEN
Last Name:PUTT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4664 PALMER CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8339
Mailing Address - Country:US
Mailing Address - Phone:888-292-0799
Mailing Address - Fax:888-655-0677
Practice Address - Street 1:1067 S HOVER ST STE E-2032
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7904
Practice Address - Country:US
Practice Address - Phone:888-292-0799
Practice Address - Fax:888-655-0677
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY587753163W00000X
CORN.1633739163W00000X
NY337227363LF0000X
CORXN.0101945-NP363LF0000X
COAPN.0992187-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse