Provider Demographics
NPI:1336505239
Name:LAVELLE, JULIANNE ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:ELIZABETH
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:TYLKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:780 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2524
Mailing Address - Country:US
Mailing Address - Phone:857-654-1000
Mailing Address - Fax:
Practice Address - Street 1:780 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2524
Practice Address - Country:US
Practice Address - Phone:857-654-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303106163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse