Healthcare Provider Details

I. General information

NPI: 1356097240
Provider Name (Legal Business Name): JULIA S BLUMENSHINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 INDEPENDENCE BLVD STE 100
VIRGINIA BEACH VA
23455-5555
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-7442
  • Fax: 757-490-3638
Mailing address:
  • Phone: 414-337-7050
  • Fax: 414-337-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011835
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: