Provider Demographics
NPI:1669405247
Name:HINZMAN, JULIE A (PAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:HINZMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:TOPONCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 GIBSON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4729
Mailing Address - Country:US
Mailing Address - Phone:505-262-7026
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3661
Practice Address - Country:US
Practice Address - Phone:505-262-7281
Practice Address - Fax:505-262-7371
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2003002363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9333231Medicaid
NM9333231Medicaid
NM341411805Medicare ID - Type Unspecified