Provider Demographics
NPI:1831175157
Name:FILE, JULIE WIMMER (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:WIMMER
Last Name:FILE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:
Practice Address - Street 1:154 GOVERNMENT CENTER DR
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-6299
Practice Address - Country:US
Practice Address - Phone:336-753-6750
Practice Address - Fax:336-450-1744
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752053AMedicare ID - Type Unspecified
S72980Medicare UPIN