Provider Demographics
NPI:1255312989
Name:MCCARDELL, JULIE KATHLEEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KATHLEEN
Last Name:MCCARDELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1807 N HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2444
Mailing Address - Country:US
Mailing Address - Phone:509-456-7414
Mailing Address - Fax:509-624-0763
Practice Address - Street 1:1700 W RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5683
Practice Address - Country:US
Practice Address - Phone:208-770-2822
Practice Address - Fax:208-770-2911
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61232280363LF0000X
ID62943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily