Healthcare Provider Details

I. General information

NPI: 1962681726
Provider Name (Legal Business Name): JULIE L PRZYBYSZEWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 STATE ROAD, NAUSET BLDG SOUTHCOAST PHYSICIAN SERVICES, INC.
NORTH DARTMOUTH MA
02747-3322
US

IV. Provider business mailing address

200 MILL ROAD, SUITE 180 SOUTHCOAST PHYSICIAN SERVICES, INC.
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-2255
  • Fax: 508-999-0387
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN234454
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number234454
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number234454
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: