Healthcare Provider Details

I. General information

NPI: 1700628526
Provider Name (Legal Business Name): JOLY WU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 LIMITED LN NW
OLYMPIA WA
98502-2704
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-1399
  • Fax:
Mailing address:
  • Phone: 253-681-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61566552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: