Provider Demographics
NPI:1548466253
Name:JULIE A DYBBRO ARNP LLC
Entity type:Organization
Organization Name:JULIE A DYBBRO ARNP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-754-9409
Mailing Address - Street 1:200 LILLY RD NE
Mailing Address - Street 2:STE B2
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5427
Mailing Address - Country:US
Mailing Address - Phone:360-754-9409
Mailing Address - Fax:360-438-6760
Practice Address - Street 1:200 LILLY RD NE
Practice Address - Street 2:STE B2
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5427
Practice Address - Country:US
Practice Address - Phone:360-754-9409
Practice Address - Fax:360-438-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004521363LF0000X
WAAP30001995363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9617192Medicaid
WADH2034OtherRRM
WA9624750Medicaid
WA8860520Medicare ID - Type UnspecifiedMARGARET ZIMMERMAN
WA9617192Medicaid
WAQ57470Medicare UPIN
WA9624750Medicaid