Provider Demographics
NPI:1205440278
Name:WORTHAM, JULIA M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:M
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:M
Other - Last Name:FORSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3451 MOUNTAIN LION DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8817
Mailing Address - Country:US
Mailing Address - Phone:970-800-9330
Mailing Address - Fax:720-927-4301
Practice Address - Street 1:3451 MOUNTAIN LION DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-8817
Practice Address - Country:US
Practice Address - Phone:970-800-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008436363A00000X
TXPA13741363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical