Provider Demographics
NPI:1053864652
Name:CUNNINGHAM, JULIE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811 222ND AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9486
Mailing Address - Country:US
Mailing Address - Phone:253-307-9874
Mailing Address - Fax:
Practice Address - Street 1:1901 S CEDAR ST STE 108
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2302
Practice Address - Country:US
Practice Address - Phone:253-212-0078
Practice Address - Fax:253-212-3877
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2019-05-11
Deactivation Date:2018-01-08
Deactivation Code:
Reactivation Date:2018-01-31
Provider Licenses
StateLicense IDTaxonomies
WAAP60821011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily