Healthcare Provider Details

I. General information

NPI: 1154219590
Provider Name (Legal Business Name): JULIANNE D'AMBROSIO FNP-BC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

15 BONAIR AVE
WAKEFIELD MA
01880-3650
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax: 978-221-6728
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2362839
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: