Provider Demographics
NPI:1962505719
Name:HIGGINS, JULIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:HIGGINS
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 1:2857 NW ADAGIO WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6868
Mailing Address - Country:US
Mailing Address - Phone:971-226-1113
Mailing Address - Fax:
Practice Address - Street 1:29756 SW TOWN CENTER LOOP W STE W
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7890
Practice Address - Country:US
Practice Address - Phone:503-685-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant