Provider Demographics
NPI:1740242940
Name:TUDOR, JULIE KATHERINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KATHERINE
Last Name:TUDOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:KATHERINE
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:910 WAINEE ST
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1622
Mailing Address - Country:US
Mailing Address - Phone:808-662-6900
Mailing Address - Fax:
Practice Address - Street 1:910 WAINEE ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1622
Practice Address - Country:US
Practice Address - Phone:808-662-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-731363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014322E14Medicare PIN
56019Medicare UPIN
S69019Medicare UPIN