Healthcare Provider Details

I. General information

NPI: 1508145103
Provider Name (Legal Business Name): JULIE EISELE RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 TACOMA ST
WORCESTER MA
01605-0007
US

IV. Provider business mailing address

PO BOX 15007
WORCESTER MA
01615-0007
US

V. Phone/Fax

Practice location:
  • Phone: 508-595-0788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number174054
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: