Provider Demographics
NPI:1962873331
Name:GILSON, JULIE (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GILSON
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 1:28555 STARBRIGHT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5662
Mailing Address - Country:US
Mailing Address - Phone:419-931-3030
Mailing Address - Fax:419-931-3048
Practice Address - Street 1:28555 STARBRIGHT BLVD STE B
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5662
Practice Address - Country:US
Practice Address - Phone:419-931-3030
Practice Address - Fax:419-931-3048
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004363363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical