Healthcare Provider Details

I. General information

NPI: 1336157114
Provider Name (Legal Business Name): JULIE A. BARBOZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE BARBOZA NP

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6842
  • Fax: 857-203-6412
Mailing address:
  • Phone: 857-203-6842
  • Fax: 857-203-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number251938
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number251938
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN251938
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: