Provider Demographics
NPI:1124006150
Name:DYBBRO, JULIE A (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:DYBBRO
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 1:200 LILLY RD NE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5427
Mailing Address - Country:US
Mailing Address - Phone:360-754-9409
Mailing Address - Fax:360-459-7223
Practice Address - Street 1:200 LILLY RD NE
Practice Address - Street 2:SUITE B2
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5427
Practice Address - Country:US
Practice Address - Phone:360-754-9409
Practice Address - Fax:360-459-7223
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7311072OtherAETNA
WA7607DYOtherREGENCE
WA9644741Medicaid
WA7607DYOtherREGENCE
WAQ57470Medicare UPIN