MEDICARE: JULIE ANN VANDUINE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0994385-NP	CO
2	163W00000X	Registered Nurse	RN0185085	CO

General Provider Information

NPI Number	:	1972071090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANN VANDUINE FNP

Provider Business Mailing Address
First Line	:	5450 WESTERN AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2709
Country	:	US
Telephone Number	:	303-415-5199
Fax Number	:	303-415-5198

Provider Business Practice Location Address
First Line	:	6685 GUNPARK DR STE 102
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-3343
Country	:	US
Telephone Number	:	303-415-5810
Fax Number	:	303-415-5820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	02/22/2019

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