=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871951616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE CERRONE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2016
-----------------------------------------------------
Last Update Date | 12/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 OCEAN AVE
-----------------------------------------------------
City | REVERE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02151-3675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-485-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 REVERE BEACH BLVD APT 10-10S
-----------------------------------------------------
City | REVERE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02151-4866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-527-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN2298948
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | RN2298948
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN2298948
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------