Healthcare Provider Details

I. General information

NPI: 1306026224
Provider Name (Legal Business Name): JULIE MARIE PRESTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR PHYSCIANS PLAZA EAST STE 110
DECATUR IL
62526-6303
US

IV. Provider business mailing address

3798 E. FULTON AVE
DECATUR IL
62521
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-2442
  • Fax: 217-424-9431
Mailing address:
  • Phone: 217-864-2700
  • Fax: 217-864-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number385000284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: