Provider Demographics
NPI:1275541823
Name:GAYANICH, JULIE (PA)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:GAYANICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 NAPA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2956
Mailing Address - Country:US
Mailing Address - Phone:405-326-9705
Mailing Address - Fax:405-285-0463
Practice Address - Street 1:448 36TH AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4743
Practice Address - Country:US
Practice Address - Phone:405-573-9905
Practice Address - Fax:405-701-0590
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1149363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243724205Medicare PIN