Provider Demographics
NPI:1982020038
Name:DOLLISON, JULIE A (CCP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:DOLLISON
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-1511
Mailing Address - Country:US
Mailing Address - Phone:903-234-0744
Mailing Address - Fax:
Practice Address - Street 1:301 S CLUB DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-1511
Practice Address - Country:US
Practice Address - Phone:903-234-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0460242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist