Basic Information
| Provider Information | |||||||||
| NPI: | 1679852792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUTON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WINN | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | APN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2643 PATTERSON RD | ||||||||
| Address2: | SUITE 605 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815061936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702982482 | ||||||||
| FaxNumber: | 9702981701 | ||||||||
| Practice Location | |||||||||
| Address1: | 2643 PATTERSON RD | ||||||||
| Address2: | SUITE 605 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815061936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702982482 | ||||||||
| FaxNumber: | 9702981701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2011 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP-990226 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 160580 | 01 | CO | STATE LICENSE | OTHER | NP-990226 | 01 | CO | NURSE PRACTITIONER | OTHER |