Provider Demographics
NPI:1912234220
Name:JOSIE, BRETT G (PA-C)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:G
Last Name:JOSIE
Suffix:
Gender:M
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 1:2202 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-3614
Mailing Address - Country:US
Mailing Address - Phone:309-786-3466
Mailing Address - Fax:309-786-1692
Practice Address - Street 1:2202 18TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-3614
Practice Address - Country:US
Practice Address - Phone:309-786-3466
Practice Address - Fax:309-786-1692
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant