Provider Demographics
NPI:1407046675
Name:WILCKEN, JULIE A (MPAS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WILCKEN
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 W 1325 N
Mailing Address - Street 2:#200
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8101
Mailing Address - Country:US
Mailing Address - Phone:435-586-7676
Mailing Address - Fax:435-586-2290
Practice Address - Street 1:110 W 1325 N
Practice Address - Street 2:#200
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8101
Practice Address - Country:US
Practice Address - Phone:435-586-7676
Practice Address - Fax:435-586-2290
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZT669363A00000X
UT7181236-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant