Individual
JULIE STACKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1528 EUREKA RD STE 103, ROSEVILLE, CA 95661-3047
(916) 772-5325
Mailing address
1528 EUREKA RD STE 103, ROSEVILLE, CA 95661-3047
(916) 772-5325
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
16221
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16221
PHYSICIAN ASSISTANT
CA
Enumeration date
07/13/2006
Last updated
03/07/2023
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