Healthcare Provider Details

I. General information

NPI: 1861585119
Provider Name (Legal Business Name): JULIANNA DEVEREAUX RHEAULT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HARRY S TRUMAN PKWY
ANNAPOLIS MD
21401-7031
US

IV. Provider business mailing address

12519 ROCKLEDGE DR
BOWIE MD
20715-3247
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-6625
  • Fax:
Mailing address:
  • Phone: 301-651-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR043915
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: