Healthcare Provider Details

I. General information

NPI: 1174006878
Provider Name (Legal Business Name): JULIE M WHEATON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

5719 NE 75TH ST
VANCOUVER WA
98661-1051
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2000
  • Fax:
Mailing address:
  • Phone: 360-241-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60898509
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN60277574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: