Provider Demographics
NPI:1306874433
Name:JULIN, MICHELE J (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:J
Last Name:JULIN
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:PO BOX 241353
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5353
Mailing Address - Country:US
Mailing Address - Phone:402-398-9243
Mailing Address - Fax:402-398-9253
Practice Address - Street 1:8005 FARNAM DR
Practice Address - Street 2:SUITE 305
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3426
Practice Address - Country:US
Practice Address - Phone:402-398-9243
Practice Address - Fax:402-398-9253
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37460OtherBCBS
IA94329OtherBCBS
098770Medicare PIN
IA94329OtherBCBS