Provider Demographics
NPI:1164553731
Name:ANDERSON, JULIE LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:ANDERSON
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 1:231 W ROCALLA AVE
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321
Mailing Address - Country:US
Mailing Address - Phone:206-760-9266
Mailing Address - Fax:206-760-9807
Practice Address - Street 1:231 W ROCALLA AVE
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321
Practice Address - Country:US
Practice Address - Phone:206-760-9266
Practice Address - Fax:206-760-9807
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00080680163W00000X
WAAP30002405363L00000X
AZAP11162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB27201Medicare UPIN