Provider Demographics
NPI:1568022614
Name:EDWARDS, JULIA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:431 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3805
Mailing Address - Country:US
Mailing Address - Phone:847-289-8822
Mailing Address - Fax:
Practice Address - Street 1:431 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3805
Practice Address - Country:US
Practice Address - Phone:847-289-8822
Practice Address - Fax:847-289-0815
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical