Provider Demographics
NPI:1114911625
Name:KACZOR, JULIE LESLIE (MSN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LESLIE
Last Name:KACZOR
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LESLIE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:STE 308
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:410-374-8427
Mailing Address - Fax:
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:STE 308
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-374-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR101251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46081Medicare UPIN