Basic Information
| Provider Information | |||||||||
| NPI: | 1164926069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | JULIETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 289 GREAT RD STE G1 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017204766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | 9784862682 | ||||||||
| Practice Location | |||||||||
| Address1: | 289 GREAT RD STE G1 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017204766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | 9784862682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2018 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN230295 | MA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | RN230295 | 01 | MA | REGISTERED NURSE LICENSE | OTHER |