Provider Demographics
NPI:1134156987
Name:BINDAS, JULIE ANN R (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE ANN
Middle Name:R
Last Name:BINDAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE ANN
Other - Middle Name:R
Other - Last Name:KENNISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10625 W NORTH AVE
Mailing Address - Street 2:102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2315
Mailing Address - Country:US
Mailing Address - Phone:414-877-5350
Mailing Address - Fax:414-877-5360
Practice Address - Street 1:10625 W NORTH AVE
Practice Address - Street 2:102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-877-5350
Practice Address - Fax:414-877-5360
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI891-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI970008766OtherMEDICARE RAILROAD
WI42982800Medicaid
WI970008767OtherMEDICARE RAILROAD
S84639Medicare UPIN
WI42982800Medicaid
WI970008767OtherMEDICARE RAILROAD