Provider Demographics
NPI:1558512996
Name:HIMSTEDT, JULIE (PA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HIMSTEDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 S 800 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2249
Mailing Address - Country:US
Mailing Address - Phone:720-244-6419
Mailing Address - Fax:
Practice Address - Street 1:1208 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2522
Practice Address - Country:US
Practice Address - Phone:801-483-1600
Practice Address - Fax:801-483-1610
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10673585-1206363AM0700X
CO2690363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC544638OtherEMPLOYER PTAN
CO341180YY4GOtherPTAN