Provider Demographics
NPI:1932217635
Name:SCHRETTNER, JULIANA (PA)
Entity Type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:
Last Name:SCHRETTNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3123
Mailing Address - Country:US
Mailing Address - Phone:719-584-4400
Mailing Address - Fax:719-543-0006
Practice Address - Street 1:1600 N GREENWOOD
Practice Address - Street 2:520
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-543-0909
Practice Address - Fax:719-543-0006
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841541697OtherUNITED HEALTH
CO841541697OtherBCBS
P14403Medicare UPIN
CO406828Medicare ID - Type Unspecified