Healthcare Provider Details

I. General information

NPI: 1508628926
Provider Name (Legal Business Name): JULIA MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST # 6
DURHAM NC
27704
US

IV. Provider business mailing address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-4000
  • Fax:
Mailing address:
  • Phone: 919-684-0105
  • Fax: 919-681-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number318866
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5019727
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: