MEDICARE: DR. JEREMY J. BEAULIEU FNPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN2334824	MA
2	363LF0000X	Family Nurse Practitioner	209010474	IL
3	363LF0000X	Family Nurse Practitioner	CNP151044	ME

General Provider Information

NPI Number	:	1427496868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY J. BEAULIEU FNPC

Provider Business Mailing Address
First Line	:	10 GOVE ST
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-1920
Country	:	US
Telephone Number	:	617-568-4872
Fax Number	:	617-568-4756

Provider Business Practice Location Address
First Line	:	1801 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4795
Country	:	US
Telephone Number	:	312-413-3631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	03/05/2026

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