Provider Demographics
NPI:1922146588
Name:BENSON, JULIE ANN (MHA,MN, ARNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BENSON
Suffix:
Gender:F
Credentials:MHA,MN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:253-426-4604
Mailing Address - Fax:253-426-4601
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-4604
Practice Address - Fax:253-426-4601
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647561Medicaid
Q64461Medicare UPIN
WAG8858651Medicare PIN
WA9647561Medicaid