MEDICARE: MRS. JULIANNA DEVEREAUX RHEAULT CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	R043915	MD

General Provider Information

NPI Number	:	1861585119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIANNA DEVEREAUX RHEAULT CRNP

Provider Business Mailing Address
First Line	:	12519 ROCKLEDGE DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-3247
Country	:	US
Telephone Number	:	301-651-1654
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 HARRY S TRUMAN PKWY
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7031
Country	:	US
Telephone Number	:	410-222-6625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	01/15/2013

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