Provider Demographics
NPI:1487983953
Name:PERTMAN, JULIE SIMPSON (CPNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:SIMPSON
Last Name:PERTMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 NORTH BROADWAY
Mailing Address - Street 2:KENNEDY KRIEGER INSTITUTE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205
Mailing Address - Country:US
Mailing Address - Phone:443-923-3240
Mailing Address - Fax:240-379-6710
Practice Address - Street 1:707 NORTH BROADWAY
Practice Address - Street 2:KENNEDY KRIEGER INSTITUTE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:443-923-3240
Practice Address - Fax:240-379-6710
Is Sole Proprietor?:No
Enumeration Date:2009-12-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153446363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR153446OtherRNLICENSE
MD019019500Medicaid