Healthcare Provider Details

I. General information

NPI: 1306120936
Provider Name (Legal Business Name): TAMIKA SIMONE JULIEN DNP, CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

428 COLUMBUS AVE CREDENTIALING SPECIALIST
NEW HAVEN CT
06519-1233
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5188
  • Fax:
Mailing address:
  • Phone: 203-503-3174
  • Fax: 203-503-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421036
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number438
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: