MEDICARE: JULIE MARIE WOODS LIDE 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	PA2567	NV

General Provider Information

NPI Number	:	1588315444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MARIE WOODS LIDE PA-C

Provider Business Mailing Address
First Line	:	10314 WOOD PLANK LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1104
Country	:	US
Telephone Number	:	775-530-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	6090 S FORT APACHE RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5618
Country	:	US
Telephone Number	:	702-202-0534
Fax Number	:

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

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	03/05/2025

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