Healthcare Provider Details

I. General information

NPI: 1891160917
Provider Name (Legal Business Name): JULIA HUNTINGTON COOK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S MAIN ST
RANDOLPH VT
05060-1381
US

IV. Provider business mailing address

47 S PLEASANT ST
RANDOLPH VT
05060-1318
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-2401
  • Fax: 802-728-2398
Mailing address:
  • Phone: 770-855-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number101.0118741
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: