Provider Demographics
NPI:1477794170
Name:HETZLER, JULIANNE HUYNH (DO)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:HUYNH
Last Name:HETZLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:HUYNH
Other - Last Name:RIENDEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:363 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3703
Practice Address - Country:US
Practice Address - Phone:508-973-5919
Practice Address - Fax:508-973-5916
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241665208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400209314Medicare PIN