Healthcare Provider Details

I. General information

NPI: 1578974911
Provider Name (Legal Business Name): JULIET ROHAN BLISS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9927 MICKELBERRY RD NW STE 131
SILVERDALE WA
98383-7861
US

IV. Provider business mailing address

9927 MICKELBERRY RD NW STE 131
SILVERDALE WA
98383-7861
US

V. Phone/Fax

Practice location:
  • Phone: 360-337-5800
  • Fax: 360-692-1392
Mailing address:
  • Phone: 360-337-5800
  • Fax: 360-692-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60769795
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: