Provider Demographics
NPI:1144210386
Name:DEAN, JULIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:DEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:KIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15735 W US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6475
Mailing Address - Country:US
Mailing Address - Phone:888-834-4551
Mailing Address - Fax:715-598-4881
Practice Address - Street 1:15954 RIVERS EDGE DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-7800
Practice Address - Country:US
Practice Address - Phone:715-634-2541
Practice Address - Fax:715-634-5740
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42992000Medicaid
P01237Medicare UPIN