Provider Demographics
NPI:1245914506
Name:JULSETH, MICHELLE CHRISTINE (PMHNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:JULSETH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CHRISTINE
Other - Last Name:HEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:1330 ROCKEFELLER AVE STE 140
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1682
Practice Address - Country:US
Practice Address - Phone:425-261-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN610919892084P0800X
WAAP61468874363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry