Healthcare Provider Details

I. General information

NPI: 1912695818
Provider Name (Legal Business Name): JULIE STATON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 COMMERCE DR
ALGONQUIN IL
60102-5916
US

IV. Provider business mailing address

25 N WINFIELD RD STE 2202
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-3522
  • Fax: 847-854-3721
Mailing address:
  • Phone: 630-307-7799
  • Fax: 630-307-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010189
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number085.010189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: