Provider Demographics
NPI:1295845683
Name:ROOT, JULIA ANN (APRN)
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:ANN
Last Name:ROOT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:ROOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS APRN
Mailing Address - Street 1:41 SOUTH ST UNIT 51
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2136
Mailing Address - Country:US
Mailing Address - Phone:413-588-2944
Mailing Address - Fax:
Practice Address - Street 1:25 BOND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3401
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169730163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1295845683Medicaid
MA169730OtherAPRN LICENSE
MA169730OtherNURSING BOARD OF EDUCATION
MR1061011LOtherMA SUBSTANCE ABUSE