Provider Demographics
NPI:1730852500
Name:MASONHEIMER, JULIANNA (PA-C)
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:MASONHEIMER
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 1:3435 DICKASON AVE APT 2215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4966
Mailing Address - Country:US
Mailing Address - Phone:678-727-3301
Mailing Address - Fax:
Practice Address - Street 1:2931 LONG PRAIRIE RD # 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4846
Practice Address - Country:US
Practice Address - Phone:972-691-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant