Healthcare Provider Details

I. General information

NPI: 1255011086
Provider Name (Legal Business Name): JULIANA GAERTE SOUZA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANA SOUZA

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 7TH AVE
LONGVIEW WA
98632-3166
US

IV. Provider business mailing address

1230 7TH AVE
LONGVIEW WA
98632-3166
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 800-813-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP.AP.61596720-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: