Provider Demographics
NPI:1891203493
Name:WINN, JULIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WINN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 WINTER ST
Mailing Address - Street 2:ATTN: BOSTON SPORTS & SHOULDER CENTER
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:781-890-2133
Mailing Address - Fax:781-890-2177
Practice Address - Street 1:130 NORTH ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3825
Practice Address - Country:US
Practice Address - Phone:508-568-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6477363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical