Provider Demographics
NPI:1316375157
Name:ARCHIBALD, JULIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ARCHIBALD
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 1:4900 S MONACO ST
Mailing Address - Street 2:STE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-837-0072
Mailing Address - Fax:303-837-0075
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:STE 3300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-837-0072
Practice Address - Fax:303-837-0075
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0003812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08151571Medicaid
CO378131YMCJMedicare PIN