Provider Demographics
NPI:1023001088
Name:DALTON, JULIE L (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:DALTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PAULORNETTE CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2838
Mailing Address - Country:US
Mailing Address - Phone:978-475-0954
Mailing Address - Fax:203-354-6182
Practice Address - Street 1:16 PAULORNETTE CIR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2838
Practice Address - Country:US
Practice Address - Phone:978-475-0954
Practice Address - Fax:781-595-7111
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS75194Medicare UPIN
MANP1668Medicare ID - Type Unspecified