Healthcare Provider Details

I. General information

NPI: 1215237896
Provider Name (Legal Business Name): JULIE MARIE ANDERSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE MARIE REMSBURG

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W MAIN ST STE 101
REXBURG ID
83440-1826
US

IV. Provider business mailing address

PO BOX 3625
IDAHO FALLS ID
83403-3625
US

V. Phone/Fax

Practice location:
  • Phone: 208-709-0478
  • Fax:
Mailing address:
  • Phone: 800-338-5378
  • Fax: 208-523-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-871
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: