Provider Demographics
NPI:1922309848
Name:VISSER, JULIANN C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIANN
Middle Name:C
Last Name:VISSER
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 1:6454 W. EMERALD STREET
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8734
Mailing Address - Country:US
Mailing Address - Phone:208-377-0820
Mailing Address - Fax:208-375-8046
Practice Address - Street 1:6454 W. EMERALD STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8734
Practice Address - Country:US
Practice Address - Phone:208-377-0820
Practice Address - Fax:208-375-8046
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant