Healthcare Provider Details

I. General information

NPI: 1255509014
Provider Name (Legal Business Name): JULIA ONEILL BRENNAN APN CANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SAINT PAUL ST
BURLINGTON VT
05401-4636
US

IV. Provider business mailing address

784 HERCULES DR STE 110
COLCHESTER VT
05446-8049
US

V. Phone/Fax

Practice location:
  • Phone: 866-476-1321
  • Fax:
Mailing address:
  • Phone: 802-448-9787
  • Fax: 802-448-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209006889
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209006889
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1010134431
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: