Healthcare Provider Details

I. General information

NPI: 1952734071
Provider Name (Legal Business Name): JULIE MARIE DUANE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 SOUTH BLOOMFIELD AVENUE
NORWALK CA
90650
US

IV. Provider business mailing address

11401 BLOOMFIELD AVE
NORWALK CA
90650
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax:
Mailing address:
  • Phone: 916-651-3154
  • Fax: 916-653-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number498772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: