Provider Demographics
NPI:1427816792
Name:BOISSELLE, JULIA E (RD)
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:E
Last Name:BOISSELLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2638
Mailing Address - Country:US
Mailing Address - Phone:508-826-5654
Mailing Address - Fax:
Practice Address - Street 1:181 WELLS AVE STE 202
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3344
Practice Address - Country:US
Practice Address - Phone:617-934-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN7324133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered