MEDICARE: JULIE LESLIE KACZOR MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R101251	MD

General Provider Information

NPI Number	:	1114911625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LESLIE KACZOR MSN

Provider Business Mailing Address
First Line	:	7505 OSLER DR
Second Line	:	STE 308
City	:	TOWSON
State	:	MD
Zip	:	21204-7736
Country	:	US
Telephone Number	:	410-374-8427
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 OSLER DR
Second Line	:	STE 308
City	:	TOWSON
State	:	MD
Zip	:	21204-7736
Country	:	US
Telephone Number	:	410-374-8427
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2007

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