Provider Demographics
NPI:1174891311
Name:CROWNOVER, JULIE D (PA)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:D
Last Name:CROWNOVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 NW MYHRE RD # 2
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7662
Mailing Address - Country:US
Mailing Address - Phone:564-240-4110
Mailing Address - Fax:564-240-4088
Practice Address - Street 1:1950 NW MYHRE RD # 2
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7662
Practice Address - Country:US
Practice Address - Phone:564-240-4110
Practice Address - Fax:564-240-4088
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6287363AS0400X
ORPA161327363AM0700X, 363AS0400X
WAPA.PA.70047821363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1174891311Medicaid
OR500652563Medicaid
OR168481Medicare PIN