Healthcare Provider Details

I. General information

NPI: 1447552260
Provider Name (Legal Business Name): JULIE LYNNE WATERBURY A.P.R.N.-F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE BROWN NP

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10420 OLD OLIVE STREET RD STE 205
SAINT LOUIS MO
63141-5937
US

IV. Provider business mailing address

10420 OLD OLIVE STREET RD STE 205
SAINT LOUIS MO
63141-5937
US

V. Phone/Fax

Practice location:
  • Phone: 314-504-4698
  • Fax: 314-692-9978
Mailing address:
  • Phone: 314-504-4698
  • Fax: 314-692-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2011023150
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2011023150
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: