Healthcare Provider Details

I. General information

NPI: 1033771977
Provider Name (Legal Business Name): JULIA MARSH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2830
US

IV. Provider business mailing address

1385 SW LESCHI DR
OAK HARBOR WA
98277-5838
US

V. Phone/Fax

Practice location:
  • Phone: 479-587-5805
  • Fax: 479-659-7930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60979473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: