Basic Information
| Provider Information | |||||||||
| NPI: | 1083655302 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNCAN | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820703704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077551000 | ||||||||
| FaxNumber: | 3077429717 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820703704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077551000 | ||||||||
| FaxNumber: | 3077429717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | 20367.0313 | WY | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health | 363LF0000X | 20367.0313 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 121773900 | 05 | WY | MEDICAID |