MEDICARE: MRS. JULIA M KOPCAK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA60258001	WA

General Provider Information

NPI Number	:	1043487309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA M KOPCAK PA-C

Provider Business Mailing Address
First Line	:	13020 MERIDIAN AVE S
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6468
Country	:	US
Telephone Number	:	206-386-4744
Fax Number	:

Provider Business Practice Location Address
First Line	:	13020 MERIDIAN AVE S
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6468
Country	:	US
Telephone Number	:	206-386-4744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	03/25/2014

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