Provider Demographics
NPI:1033463039
Name:NEVAREZ, JULIA (FNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:KACZOROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-421-1000
Practice Address - Fax:617-536-1891
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily