Healthcare Provider Details

I. General information

NPI: 1104640804
Provider Name (Legal Business Name): JULIE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 111TH AVE NE
BELLEVUE WA
98004-4486
US

IV. Provider business mailing address

719 GLEN ROCK PL
ARLINGTON TX
76014-2134
US

V. Phone/Fax

Practice location:
  • Phone: 877-345-5300
  • Fax: 561-989-3665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18840
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.61677443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: