Provider Demographics
NPI:1811957178
Name:DUEIS, JULIE J (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:J
Last Name:DUEIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:J
Other - Last Name:SEVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0996
Mailing Address - Country:US
Mailing Address - Phone:208-664-4026
Mailing Address - Fax:208-664-4840
Practice Address - Street 1:111 S 11TH AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3242
Practice Address - Country:US
Practice Address - Phone:509-573-3530
Practice Address - Fax:509-573-3535
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6825270Medicaid
SD6825272Medicaid
SD4995843OtherWELLMARK BCBS PIN
SD6825273Medicaid
SD6825272Medicaid
P00084544Medicare PIN
SDS103439Medicare PIN
SD4995843OtherWELLMARK BCBS PIN
SD6825270Medicaid
SDS41664Medicare PIN