Healthcare Provider Details

I. General information

NPI: 1366565004
Provider Name (Legal Business Name): JULIA A FONTE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 E 116TH ST
CARMEL IN
46032-4506
US

IV. Provider business mailing address

529 E 116TH ST
CARMEL IN
46032-4506
US

V. Phone/Fax

Practice location:
  • Phone: 317-341-4311
  • Fax: 317-564-4459
Mailing address:
  • Phone: 317-341-4311
  • Fax: 317-564-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71000681A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71000681A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number28071739A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number28071739A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: