Healthcare Provider Details

I. General information

NPI: 1457596876
Provider Name (Legal Business Name): KENDRA JUHOLA PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL
BOSTON MA
02215-5306
US

IV. Provider business mailing address

8 KENWOOD ST APT 4
CAMBRIDGE MA
02139-4411
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-2603
  • Fax: 617-732-2451
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2008002883
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: