=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083170070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ANN THOMAS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2019
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 10TH AVE SW
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98848-1376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-787-3531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 10TH AVE SW
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98848-1376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-787-3531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 11001408
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 60942404
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------