Healthcare Provider Details

I. General information

NPI: 1003886599
Provider Name (Legal Business Name): JULIA MCDOUGAL RONCONI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 AUSTINE DR
BRATTLEBORO VT
05301-7040
US

IV. Provider business mailing address

160 GUILFORD ST
BRATTLEBORO VT
05301-6295
US

V. Phone/Fax

Practice location:
  • Phone: 802-380-1971
  • Fax: 802-419-3844
Mailing address:
  • Phone: 802-380-1971
  • Fax: 802-419-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3336954405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0886663
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0086663
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2295461
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2295461
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: