1316080328 NPI number — JULIE A DECUIRE

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316080328 NPI number — JULIE A DECUIRE

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DECUIRE

Provider First Name:

JULIE

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

SKELTON

Provider Other First Name:

JULIE

Provider Other Middle Name:

ANN

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1316080328

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/25/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1519 132ND ST SE

Provider Second Line Business Mailing Address:

SUITE A

Provider Business Mailing Address City Name:

EVERETT

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

98208-7203

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

425-330-0633

Provider Business Mailing Address Fax Number:

425-338-9637

Provider First Line Business Practice Location Address:

22500 NE MARKETPLACE DR

Provider Second Line Business Practice Location Address:

SUITE 204

Provider Business Practice Location Address City Name:

REDMOND

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

98053-2033

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

425-836-1034

Provider Business Practice Location Address Fax Number:

425-836-1037

Provider Enumeration Date:

02/15/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  PT00008629 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0218066 . This is a "DEPT. OF LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 3499DE . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 7762900 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0232275 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 8943763 . This is a "L&I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: P00417127 . This is a "RAILROAD MEDIARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: G8872199 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 2250DE . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 8474595 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 8870905 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: P00473358 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".