Provider Demographics
NPI:1366565004
Name:FONTE, JULIA A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:FONTE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4506
Mailing Address - Country:US
Mailing Address - Phone:317-341-4311
Mailing Address - Fax:317-564-4459
Practice Address - Street 1:529 E 116TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4506
Practice Address - Country:US
Practice Address - Phone:317-341-4311
Practice Address - Fax:317-564-4459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000681A363LA2200X, 363LP0200X
IN28071739A363LX0001X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology