Provider Demographics
NPI:1982745873
Name:DUNN, JULIE (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TEMPLE ST
Mailing Address - Street 2:STE 4A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2715
Mailing Address - Country:US
Mailing Address - Phone:203-777-0304
Mailing Address - Fax:203-401-4687
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-777-0304
Practice Address - Fax:203-401-4687
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002553363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004223836Medicaid
CT500000699Medicare ID - Type Unspecified
CTP40169Medicare UPIN