Healthcare Provider Details

I. General information

NPI: 1003624693
Provider Name (Legal Business Name): JULLIET NASSUUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TURNPIKE ST STE 32A
CANTON MA
02021-2853
US

IV. Provider business mailing address

1431 ARBORETUM WAY
BURLINGTON MA
01803-3840
US

V. Phone/Fax

Practice location:
  • Phone: 781-236-7343
  • Fax:
Mailing address:
  • Phone: 617-710-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2301510
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2301510
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: