Provider Demographics
NPI:1184221921
Name:ESTRADA JUHLIN, EDITH (APRN-BC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:ESTRADA JUHLIN
Suffix:
Gender:
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:DEVENS
Mailing Address - State:MA
Mailing Address - Zip Code:01434-4401
Mailing Address - Country:US
Mailing Address - Phone:978-615-5223
Mailing Address - Fax:
Practice Address - Street 1:30 KATHLEEN DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1902
Practice Address - Country:US
Practice Address - Phone:310-633-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2334377163W00000X
MARN23334377363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse