Provider Demographics
NPI:1710476973
Name:MONTAUK-MOSCHLER, JULIETTE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:MONTAUK-MOSCHLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1803
Mailing Address - Country:US
Mailing Address - Phone:434-791-3630
Mailing Address - Fax:434-791-4126
Practice Address - Street 1:705 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1803
Practice Address - Country:US
Practice Address - Phone:434-791-3412
Practice Address - Fax:434-791-4126
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health