Provider Demographics
NPI:1811079684
Name:EDWARDS, JULIE D (PAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885
Mailing Address - Country:US
Mailing Address - Phone:401-247-1000
Mailing Address - Fax:401-247-1971
Practice Address - Street 1:851 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885
Practice Address - Country:US
Practice Address - Phone:401-247-1000
Practice Address - Fax:401-247-1971
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P51346Medicare UPIN
979003965Medicare PIN