Provider Demographics
NPI:1235565128
Name:MACGREGOR, JULIE (PA-C, LE)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MACGREGOR
Suffix:
Gender:F
Credentials:PA-C, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 S BALTIC PL STE 109
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5935
Mailing Address - Country:US
Mailing Address - Phone:208-600-2679
Mailing Address - Fax:
Practice Address - Street 1:82 S BALTIC PL STE 109
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5935
Practice Address - Country:US
Practice Address - Phone:086-002-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1613363AM0700X
ORPA165087363AS0400X
IDEE-285937247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical