Provider Demographics
NPI:1275006033
Name:PENTON, GAOJUA JULIET
Entity type:Individual
Prefix:
First Name:GAOJUA
Middle Name:JULIET
Last Name:PENTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BLACK HILLS LN SW STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8144
Mailing Address - Country:US
Mailing Address - Phone:360-754-1735
Mailing Address - Fax:
Practice Address - Street 1:406 BLACK HILLS LN SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8144
Practice Address - Country:US
Practice Address - Phone:360-754-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAARNP.AP.61206341-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner