Provider Demographics
NPI:1053459479
Name:PETERS, JULI (LMP LMT)
Entity Type:Individual
Prefix:
First Name:JULI
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMP LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 NE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2857
Mailing Address - Country:US
Mailing Address - Phone:360-690-1358
Mailing Address - Fax:360-737-8337
Practice Address - Street 1:410 E 20TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3316
Practice Address - Country:US
Practice Address - Phone:360-690-1358
Practice Address - Fax:360-737-8337
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist