Provider Demographics
NPI:1669851382
Name:FITZWILLIAM, JULIE (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:FITZWILLIAM
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 N CENTER ST APT 407
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1790
Mailing Address - Country:US
Mailing Address - Phone:801-557-4658
Mailing Address - Fax:
Practice Address - Street 1:525 E 100 S STE 5000
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1992
Practice Address - Country:US
Practice Address - Phone:801-585-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9514350-3102163WP0808X
UT9514350-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health