Provider Demographics
NPI:1700982105
Name:VENN, JULIE A
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:VENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4012
Mailing Address - Country:US
Mailing Address - Phone:253-288-8835
Mailing Address - Fax:253-288-9621
Practice Address - Street 1:101 5TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4012
Practice Address - Country:US
Practice Address - Phone:253-288-8835
Practice Address - Fax:253-793-0069
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602568702332BC3200X
WA601954769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVE5370OtherREGENCE
WA9057571Medicaid
WA126913001OtherCIGNA MEDICARE DMERC