Provider Demographics
NPI:1609142843
Name:TEA, JULIE MARIE (MD)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:MARIE
Last Name:TEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:TEA
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:PO BOX 5371
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-7370
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA128531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics