Provider Demographics
NPI:1831858968
Name:MARTIN, JULIE CATHERINE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CATHERINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2630
Mailing Address - Country:US
Mailing Address - Phone:425-320-6677
Mailing Address - Fax:
Practice Address - Street 1:205 N ALDER AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8907
Practice Address - Country:US
Practice Address - Phone:360-283-4000
Practice Address - Fax:360-283-4417
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60029019163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60029019OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WARN60029019OtherWASHINGTON STATE DEPARTMENT OF HEALTH