Provider Demographics
NPI:1730634940
Name:RICHARDS, JULIANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:WIGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:45 FRANCIS ST
Mailing Address - Street 2:ASB-2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6105
Mailing Address - Country:US
Mailing Address - Phone:617-525-3000
Mailing Address - Fax:
Practice Address - Street 1:45 FRANCIS ST
Practice Address - Street 2:ASB-2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-525-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
MAPA5839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMW1056818JOtherMASSACHUSETTS CONTROLLED SUBSTANCE REGISTRATION
MAPA5839OtherPA STATE LICENSE
MAMW4014813OtherDEA LICENSE