Provider Demographics
NPI:1588817944
Name:BERNSTEIN, JULIANA MOGIELNICKI (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:MOGIELNICKI
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:ROBERTS
Other - Last Name:MOGIELNICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:PPV350
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8562
Mailing Address - Fax:503-494-6324
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:PPV350
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8562
Practice Address - Fax:503-494-6324
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60058289363AM0700X
ORPA154104363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0243061OtherL & I
WA8532269Medicaid
WA0243061OtherL & I