Healthcare Provider Details

I. General information

NPI: 1932155041
Provider Name (Legal Business Name): JULIA CORWIN MS, PA-C; MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 COLLEGE DR
MOUNT CARMEL IL
62863-2638
US

IV. Provider business mailing address

1418 COLLEGE DR
MOUNT CARMEL IL
62863-2638
US

V. Phone/Fax

Practice location:
  • Phone: 618-263-6400
  • Fax:
Mailing address:
  • Phone: 618-263-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096001438
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005613
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: