Provider Demographics
NPI:1578962353
Name:DYMOCK, JULIE LYNNE
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNNE
Last Name:DYMOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:UT
Mailing Address - Zip Code:84328-0098
Mailing Address - Country:US
Mailing Address - Phone:435-512-0291
Mailing Address - Fax:435-797-7432
Practice Address - Street 1:175 W 1400 N STE A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6816
Practice Address - Country:US
Practice Address - Phone:435-752-5302
Practice Address - Fax:435-753-9007
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program