Provider Demographics
NPI:1558698399
Name:NIEDENS, JULIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:NIEDENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 FARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1077
Mailing Address - Country:US
Mailing Address - Phone:619-368-6586
Mailing Address - Fax:
Practice Address - Street 1:1685 E MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5292
Practice Address - Country:US
Practice Address - Phone:619-881-4568
Practice Address - Fax:619-442-6398
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant