Provider Demographics
NPI:1952326738
Name:THOMAS, JULIE A (PAC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 17TH ST
Mailing Address - Street 2:MAIL STOP 316
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0001
Mailing Address - Country:US
Mailing Address - Phone:775-784-1533
Mailing Address - Fax:775-784-8075
Practice Address - Street 1:123 17TH ST
Practice Address - Street 2:MAIL STOP 316
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0001
Practice Address - Country:US
Practice Address - Phone:775-784-1533
Practice Address - Fax:775-784-8075
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508420Medicaid
NV100508420Medicaid
NVV114744Medicare PIN
NVV103073Medicare PIN