Provider Demographics
NPI:1346290319
Name:BORDELL, JULIA N (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:N
Last Name:BORDELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 STATE ROUTE 257 STE 108
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2946
Mailing Address - Country:US
Mailing Address - Phone:814-677-3717
Mailing Address - Fax:814-677-8914
Practice Address - Street 1:3512 STATE ROUTE 257 STE 108
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2946
Practice Address - Country:US
Practice Address - Phone:814-677-6381
Practice Address - Fax:814-677-8914
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003038L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031465670001Medicaid