Healthcare Provider Details

I. General information

NPI: 1427005545
Provider Name (Legal Business Name): JULIE A NEVILLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A GRUNDMAN

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WESTERN HILLS BLVD
CHEYENNE WY
82009-3446
US

IV. Provider business mailing address

123 WESTERN HILLS BLVD
CHEYENNE WY
82009-3446
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-0226
  • Fax: 307-635-1924
Mailing address:
  • Phone: 307-635-0226
  • Fax: 307-635-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number040018
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7675A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: