Provider Demographics
NPI:1063038305
Name:PROSSER, JULIA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:PROSSER
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 1:233 COLLEGE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3385
Mailing Address - Country:US
Mailing Address - Phone:717-740-5750
Mailing Address - Fax:717-690-8829
Practice Address - Street 1:233 COLLEGE AVE STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3385
Practice Address - Country:US
Practice Address - Phone:717-740-5750
Practice Address - Fax:717-690-8829
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005266363A00000X
PAMA061607363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant