Healthcare Provider Details

I. General information

NPI: 1124006150
Provider Name (Legal Business Name): JULIE A DYBBRO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LILLY RD NE SUITE B2
OLYMPIA WA
98506-5427
US

IV. Provider business mailing address

200 LILLY RD NE BLDG 2
OLYMPIA WA
98506-5427
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-9409
  • Fax: 360-459-7223
Mailing address:
  • Phone: 360-754-9409
  • Fax: 360-459-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004521
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: