Healthcare Provider Details

I. General information

NPI: 1285579011
Provider Name (Legal Business Name): JULIA ROBERTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RICKER RD
SALEM IL
62881-4263
US

IV. Provider business mailing address

1201 RICKER RD
SALEM IL
62881-4263
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-3194
  • Fax:
Mailing address:
  • Phone: 618-548-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: