Provider Demographics
NPI:1144263724
Name:DAVIAN, JULIE A (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:DAVIAN
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 1:20000 HARVARD AVE
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6805
Mailing Address - Country:US
Mailing Address - Phone:216-991-2600
Mailing Address - Fax:330-255-5088
Practice Address - Street 1:20000 HARVARD AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6805
Practice Address - Country:US
Practice Address - Phone:216-991-2600
Practice Address - Fax:330-255-5088
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000981363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097555Medicaid
OH0097555Medicaid