Provider Demographics
NPI:1922330737
Name:GODFREY, JULIA ELIZABETH KNAUS (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ELIZABETH KNAUS
Last Name:GODFREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-447-2189
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-447-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant