Provider Demographics
NPI:1336248129
Name:TAYLOR, JULIA ANN (PAC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 5TH AVE
Mailing Address - Street 2:330W
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-624-1184
Mailing Address - Fax:509-625-1449
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:330W
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-624-1184
Practice Address - Fax:509-625-1449
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA0003959363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA070010731OtherRAILROAD MEDICARE
WAQ10325Medicare UPIN
WAG008801926Medicare PIN