Provider Demographics
NPI:1508949009
Name:ANDERSON, JULIE (RPA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6097 U.S. RTE. 9 N
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:12993
Mailing Address - Country:US
Mailing Address - Phone:518-962-2313
Mailing Address - Fax:
Practice Address - Street 1:6097 U.S. RTE. 9N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:NY
Practice Address - Zip Code:12993
Practice Address - Country:US
Practice Address - Phone:518-962-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006291363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141364513OtherTAX ID