Provider Demographics
NPI:1144784117
Name:THAKKAR, JULIE P (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:P
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM,MSN
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 HARRISON AVENUE, FL 4
Practice Address - Street 2:YAWKEY BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-2000
Practice Address - Fax:617-414-5798
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306615363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health