Healthcare Provider Details

I. General information

NPI: 1841378718
Provider Name (Legal Business Name): JULIE M BLOMDAHL RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 NE 99TH CIR
VANCOUVER WA
98662-1300
US

IV. Provider business mailing address

3333 N WHITMAN ST
TACOMA WA
98407-1547
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-0880
  • Fax:
Mailing address:
  • Phone: 253-759-3065
  • Fax: 253-759-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00099981
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: