Provider Demographics
NPI:1457482044
Name:MILLER, JULIE R (LMT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20825 STATE ROUTE 410 E # 260
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6301
Mailing Address - Country:US
Mailing Address - Phone:253-230-5723
Mailing Address - Fax:253-826-0511
Practice Address - Street 1:603 HUNT AVE
Practice Address - Street 2:STE A
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1117
Practice Address - Country:US
Practice Address - Phone:253-230-5723
Practice Address - Fax:253-826-0511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA201396144259OtherPREMERA BLUE CROSS
WA0144672OtherDEPT OF LABOR & INDUSTRY
WA5362MIOtherREGENCE BLUE SHIELD