Basic Information
| Provider Information | |||||||||
| NPI: | 1780213488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANASSE | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064053730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034886358 | ||||||||
| FaxNumber: | 2034815327 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064053730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034886358 | ||||||||
| FaxNumber: | 2034815327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2020 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5072 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.