Provider Demographics
NPI:1366723934
Name:DATEO, JULIE MARIE (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:DATEO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:DATEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3002
Mailing Address - Country:US
Mailing Address - Phone:781-444-4924
Mailing Address - Fax:
Practice Address - Street 1:38 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-3002
Practice Address - Country:US
Practice Address - Phone:781-444-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN212810363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health