Provider Demographics
NPI:1598322638
Name:KACZ, JULIE (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:KACZ
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OLD FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4503
Mailing Address - Country:US
Mailing Address - Phone:716-909-5472
Mailing Address - Fax:
Practice Address - Street 1:10175 NIAGARA FALLS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2941
Practice Address - Country:US
Practice Address - Phone:716-205-0170
Practice Address - Fax:716-205-0818
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672942-1163W00000X
NY344869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse