Provider Demographics
NPI:1033276324
Name:YOUNG, JULIE A (PA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1802 S. MATTIS AVENUE
Practice Address - Street 2:ORTHOPEDICS
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821
Practice Address - Country:US
Practice Address - Phone:217-383-3260
Practice Address - Fax:217-383-4459
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085-000944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447860013Medicare NSC
ILIL3270489Medicare PIN
ILS31977Medicare UPIN
S31977Medicare UPIN