Healthcare Provider Details

I. General information

NPI: 1063898351
Provider Name (Legal Business Name): JULIE LEBEL BORDUA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBRAHAM RD
SPRINGFIELD MA
01109-3161
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-3710
  • Fax: 413-794-9595
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2292038
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: