Provider Demographics
NPI:1053682807
Name:GULIAN, HEATHER JO PETERSON (NP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO PETERSON
Last Name:GULIAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 MARKET ST
Mailing Address - Street 2:STE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3223
Mailing Address - Country:US
Mailing Address - Phone:253-692-5811
Mailing Address - Fax:253-692-4768
Practice Address - Street 1:1742 MARKET ST
Practice Address - Street 2:STE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3223
Practice Address - Country:US
Practice Address - Phone:253-692-5811
Practice Address - Fax:253-692-4768
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60112793163W00000X
WAAP60266522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0299850OtherSTATE L&I
WA0302436OtherSTATE L&I
WA0302680OtherSTATE L&I
WAG8913161Medicare PIN
WA0302680OtherSTATE L&I