1689076937 NPI number — JULIE EAKER PHYSICIAN ASSISTANT

Table of content: JULIE EAKER PHYSICIAN ASSISTANT (NPI 1689076937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689076937 NPI number — JULIE EAKER PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EAKER
Provider First Name:
JULIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689076937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEAVERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96093-2460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-623-3735
Provider Business Mailing Address Fax Number:
530-623-1196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 TRINITY LAKES BLVD, SUITE 2969
Provider Second Line Business Practice Location Address:
31660 STATE HIGHWAY 3
Provider Business Practice Location Address City Name:
WEAVERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96093-2969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-623-6777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  51928 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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