Healthcare Provider Details

I. General information

NPI: 1093876518
Provider Name (Legal Business Name): JULIE ELIZABETH HURLEY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY ST DANA FARBER CANCER INST MAIL CODE DIB 30
BOSTON MA
02115-6084
US

IV. Provider business mailing address

117 HEALTH ST #2
SOMERVILLE MA
02145
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8053
  • Fax: 617-278-6965
Mailing address:
  • Phone: 617-699-8901
  • Fax: 617-278-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAP2263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: