Healthcare Provider Details

I. General information

NPI: 1548466253
Provider Name (Legal Business Name): JULIE A DYBBRO ARNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 360-754-9409
  • Fax: 360-438-6760
Mailing address:
  • Phone: 360-754-9409
  • Fax: 360-438-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004521
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30001995
License Number StateWA

VIII. Authorized Official

Name: AMY KUNKEL
Title or Position: MANAGER
Credential:
Phone: 360-754-9409