Provider Demographics
NPI:1952463176
Name:CHURCH, JULIE A (RD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:CHURCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ROOSEVELT WAY NE STE 300D
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2253
Mailing Address - Country:US
Mailing Address - Phone:206-854-8959
Mailing Address - Fax:206-985-2679
Practice Address - Street 1:9500 ROOSEVELT WAY NE STE 300D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2253
Practice Address - Country:US
Practice Address - Phone:206-854-8959
Practice Address - Fax:206-985-2679
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3690CHOtherREGENCE BLUE SHIELD INSUR