Provider Demographics
NPI:1083086730
Name:VANDERDASSON, JULEE (LPN)
Entity Type:Individual
Prefix:
First Name:JULEE
Middle Name:
Last Name:VANDERDASSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-0369
Mailing Address - Country:US
Mailing Address - Phone:509-427-3850
Mailing Address - Fax:509-427-0188
Practice Address - Street 1:710 SW ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-4418
Practice Address - Country:US
Practice Address - Phone:509-427-3850
Practice Address - Fax:509-427-0188
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00050080164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse