Provider Demographics
NPI:1063840411
Name:ANCERO, JULIE
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:
Last Name:ANCERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 NE BLOSSOM PL
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9520
Mailing Address - Country:US
Mailing Address - Phone:360-471-3433
Mailing Address - Fax:
Practice Address - Street 1:9216 BAYSHORE DR NW STE 200
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8533
Practice Address - Country:US
Practice Address - Phone:360-692-4111
Practice Address - Fax:360-692-4999
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60398440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist