Provider Demographics
NPI:1114975489
Name:ROUBAL, JULIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:ROUBAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 N 96TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2497
Mailing Address - Country:US
Mailing Address - Phone:402-330-4555
Mailing Address - Fax:402-330-4626
Practice Address - Street 1:909 N 96TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2497
Practice Address - Country:US
Practice Address - Phone:402-330-4555
Practice Address - Fax:402-330-4626
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1132363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ15714Medicare UPIN
NE281566Medicare PIN