Provider Demographics
NPI:1306026224
Name:PRESTON, JULIE MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MARIE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3798 E. FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521
Mailing Address - Country:US
Mailing Address - Phone:217-864-2700
Mailing Address - Fax:217-864-3930
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:PHYSCIANS PLAZA EAST STE 110
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6303
Practice Address - Country:US
Practice Address - Phone:217-422-2442
Practice Address - Fax:217-424-9431
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL385000284363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP05155Medicare UPIN