Provider Demographics
NPI:1932490489
Name:SWAFFORD, JULIA MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:MARIE
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:HOEKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2845 CAPITAL AVE SW
Mailing Address - Street 2:STE. 302
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4185
Mailing Address - Country:US
Mailing Address - Phone:269-979-6333
Mailing Address - Fax:269-979-6335
Practice Address - Street 1:2845 CAPITAL AVE SW
Practice Address - Street 2:STE. 302
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4185
Practice Address - Country:US
Practice Address - Phone:269-979-6333
Practice Address - Fax:269-979-6335
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant