Provider Demographics
NPI:1447275268
Name:STACKHOUSE, JULIE (PA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:STACKHOUSE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:HOADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1528 EUREKA RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3047
Mailing Address - Country:US
Mailing Address - Phone:916-772-5325
Mailing Address - Fax:
Practice Address - Street 1:1528 EUREKA RD STE 103
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3047
Practice Address - Country:US
Practice Address - Phone:916-772-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16221363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16221OtherPHYSICIAN ASSISTANT
CA16221OtherPHYSICIAN ASSISTANT
CAP63469Medicare UPIN