Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | RN2306529 | MA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN2306529 | MA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN2306529 | MA |
NPI | 1003572413 |
---|---|
Provider Name | Julia Marvel |
First Address | Waltham, MA 02453-1515 |
Second Address | Waltham, MA 02453-1515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2021 |
Last Update Date | 10/11/2021 |