Healthcare Provider Details

I. General information

NPI: 1811136724
Provider Name (Legal Business Name): JULIA R DEMITROS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 1440
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

1229 MADISON ST SUITE 1440
SEATTLE WA
98104-3586
US

V. Phone/Fax

Practice location:
  • Phone: 206-625-0578
  • Fax: 206-625-9184
Mailing address:
  • Phone: 206-625-0578
  • Fax: 206-625-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60673441
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: