=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689076937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE EAKER PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2014
-----------------------------------------------------
Last Update Date | 05/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 TRINITY LAKES BLVD, SUITE 2969 31660 STATE HIGHWAY 3
-----------------------------------------------------
City | WEAVERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96093-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-623-6777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 MAIN ST
-----------------------------------------------------
City | WEAVERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96093-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-623-3735
-----------------------------------------------------
Fax | 530-623-1196
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 51928
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------