Basic Information
| Provider Information | |||||||||
| NPI: | 1285779843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHLEUDER | ||||||||
| FirstName: | JULIANN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1492 S MILL AVE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852815676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808945550 | ||||||||
| FaxNumber: | 4808949469 | ||||||||
| Practice Location | |||||||||
| Address1: | 890 W ELLIOT RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852335102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805452787 | ||||||||
| FaxNumber: | 9198829575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1274 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 5522 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0076372 | 05 | IA | MEDICAID |