Provider Demographics
NPI:1497721666
Name:GREEN, JULIE K (PA)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:K
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 360301
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-4124
Mailing Address - Country:US
Mailing Address - Phone:844-969-0686
Mailing Address - Fax:773-832-7083
Practice Address - Street 1:1107 S LEMAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3959
Practice Address - Country:US
Practice Address - Phone:970-449-0315
Practice Address - Fax:970-823-7007
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3681363A00000X
VA0110002168363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
009076A34Medicare ID - Type Unspecified
Q56544Medicare UPIN