Healthcare Provider Details

I. General information

NPI: 1649589185
Provider Name (Legal Business Name): JULIE LEADER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD ROLLINSFORD RD BUILDING B
DOVER NH
03820-2868
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-4265
  • Fax:
Mailing address:
  • Phone: 603-516-4265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number04858823
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: