Healthcare Provider Details

I. General information

NPI: 1760881338
Provider Name (Legal Business Name): JULIE SHATTUCK HEHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PURDY HILL RD
MONROE CT
06468-2244
US

IV. Provider business mailing address

114 PURDY HILL RD
MONROE CT
06468-2244
US

V. Phone/Fax

Practice location:
  • Phone: 203-257-7746
  • Fax:
Mailing address:
  • Phone: 203-257-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005789
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: