Provider Demographics
NPI:1225444920
Name:BLY, JULIE ROSE (RD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ROSE
Last Name:BLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 NE 140TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2223
Mailing Address - Country:US
Mailing Address - Phone:425-760-0867
Mailing Address - Fax:
Practice Address - Street 1:12121 NE 140TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2223
Practice Address - Country:US
Practice Address - Phone:425-760-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA997358133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered