1780886218 NPI number — MS. JULIE ANN POWERS CDP

Table of content: MS. JULIE ANN POWERS CDP (NPI 1780886218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780886218 NPI number — MS. JULIE ANN POWERS CDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWERS
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CDP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POWERS
Provider Other First Name:
JULIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CDP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780886218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3411 MADRONA BEACH RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-8809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-866-1821
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 N TRIBAL CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOKOMISH NATION
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98584-9748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-426-7788
Provider Business Practice Location Address Fax Number:
360-877-6585
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CP00002317 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1980796 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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