Provider Demographics
NPI:1700890886
Name:SULLIVAN, JULIE A (APRN, PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:GERACI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 HARREL ST
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8526
Mailing Address - Country:US
Mailing Address - Phone:802-888-5026
Mailing Address - Fax:802-888-6393
Practice Address - Street 1:72 HARREL ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8526
Practice Address - Country:US
Practice Address - Phone:802-888-5026
Practice Address - Fax:802-888-6393
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0025249363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2158131OtherCIGNA
VT00049858OtherBC/BS OF VT
VT0NS2022Medicaid
VT360340OtherTRICARE
VTNS2022Medicare PIN
VT0NS2022Medicaid