Provider Demographics
NPI:1871862284
Name:KORSSJOEN, JULIE KRISTEN (LMP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KRISTEN
Last Name:KORSSJOEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13710 461ST PL SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8865
Mailing Address - Country:US
Mailing Address - Phone:425-888-0460
Mailing Address - Fax:
Practice Address - Street 1:13710 461ST PL SE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8865
Practice Address - Country:US
Practice Address - Phone:425-888-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60258944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist