Provider Demographics
NPI:1114197241
Name:REAVILL, JULIE ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:REAVILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HOLYCROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:614 N GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3940
Mailing Address - Country:US
Mailing Address - Phone:217-442-8790
Mailing Address - Fax:217-442-3495
Practice Address - Street 1:1808 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1726
Practice Address - Country:US
Practice Address - Phone:217-597-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002687363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical