Healthcare Provider Details

I. General information

NPI: 1639000581
Provider Name (Legal Business Name): JULIE STEVENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE DUMONT

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

309 SCHOOL ST SE APT 4
LACEY WA
98503-6701
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1110
  • Fax:
Mailing address:
  • Phone: 302-943-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number119275
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: