Healthcare Provider Details

I. General information

NPI: 1780144659
Provider Name (Legal Business Name): JULIE ODONNELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E MEEKER ST STE 200
KENT WA
98030-5904
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-2866
  • Fax: 253-852-3102
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-177-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61377168
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: