Healthcare Provider Details

I. General information

NPI: 1962098350
Provider Name (Legal Business Name): JULIANA LYNN HITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 CHERRY AVE
BREMERTON WA
98310-4203
US

IV. Provider business mailing address

198 MADRONA WAY NE
BAINBRIDGE ISLAND WA
98110-1869
US

V. Phone/Fax

Practice location:
  • Phone: 360-744-6910
  • Fax:
Mailing address:
  • Phone: 185-976-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN60962451
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: