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Individual

JULIE MACGREGOR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C, LE

Contact information

Practice address
82 S BALTIC PL STE 109, MERIDIAN, ID 83642-5935
(086) 002-6792
Mailing address
82 S BALTIC PL STE 109, MERIDIAN, ID 83642-5935
(208) 600-2679

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
EE-285937
ID
363AM0700X
Medical Physician Assistant
PA-1613
ID
363AS0400X
Surgical Physician Assistant
PA165087
OR

Other

Enumeration date
09/24/2013
Last updated
09/30/2024
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