Healthcare Provider Details

I. General information

NPI: 1568445583
Provider Name (Legal Business Name): JULIE BETH VERNOLD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH ST.
WALTON NY
13856
US

IV. Provider business mailing address

130 NORTH ST
WALTON NY
13856-1218
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-6541
  • Fax: 607-865-6541
Mailing address:
  • Phone: 607-865-6541
  • Fax: 607-865-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3332241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: