Provider Demographics
NPI:1386727741
Name:RAKE, JULIE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:RAKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5030 S MILL AVE
Mailing Address - Street 2:STE D12
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6833
Mailing Address - Country:US
Mailing Address - Phone:480-894-2823
Mailing Address - Fax:480-756-6663
Practice Address - Street 1:5030 S MILL AVE
Practice Address - Street 2:STE D12
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6833
Practice Address - Country:US
Practice Address - Phone:480-894-2823
Practice Address - Fax:480-756-6663
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2014-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ63795Medicare UPIN