Provider Demographics
NPI:1669137469
Name:BARNETT, JULIE R (LAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:BARNETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2720
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-2720
Mailing Address - Country:US
Mailing Address - Phone:530-412-3710
Mailing Address - Fax:
Practice Address - Street 1:6921 NORTH LAKE BLVD
Practice Address - Street 2:
Practice Address - City:TAHOE VISTA
Practice Address - State:CA
Practice Address - Zip Code:96148
Practice Address - Country:US
Practice Address - Phone:530-412-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8631171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist