Healthcare Provider Details

I. General information

NPI: 1972046712
Provider Name (Legal Business Name): JULIE ELLAN ARCHIBALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ST NW SA-1 COLUMBIA PLAZA SUITE L 201
WASHINGTON DC
20522-9763
US

IV. Provider business mailing address

2230 ASTANA PLACE
WASHINGTON DC
20521-2230
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-1692
  • Fax:
Mailing address:
  • Phone:
  • Fax: 901-457-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number255233
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009125
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP500023903
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: