Provider Demographics
NPI:1689076937
Name:EAKER, JULIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:EAKER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-2460
Mailing Address - Country:US
Mailing Address - Phone:530-623-3735
Mailing Address - Fax:530-623-1196
Practice Address - Street 1:500 TRINITY LAKES BLVD, SUITE 2969
Practice Address - Street 2:31660 STATE HIGHWAY 3
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093-2969
Practice Address - Country:US
Practice Address - Phone:530-623-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant