Provider Demographics
NPI:1174006878
Name:WHEATON, JULIE M (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:WHEATON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1675 SW MARLOW AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5102
Mailing Address - Country:US
Mailing Address - Phone:503-430-1777
Mailing Address - Fax:503-372-5119
Practice Address - Street 1:5601 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4601
Practice Address - Country:US
Practice Address - Phone:503-430-1777
Practice Address - Fax:503-372-5119
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60277574163WW0000X
WAAP60898509363L00000X
OR201240188RN163W00000X
OR201809507NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAG60898509OtherWASHINGTON DEPARTMENT OF HEALTH - STATE BOARD OF NURSING
OR201240188RNOtherOREGON STATE BOARD OF NURSING
OR201809507NP-PPOtherOREGON STATE BOARD OF NURSING
AG09180197OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
WARN60277574OtherWA DEPARTMENT OF HEALTH - STATE BOARD OF NURSING