Basic Information
| Provider Information | |||||||||
| NPI: | 1962975219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUAU | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | LYNN DODGEN | ||||||||
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| Credential: | NNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13410 N LEAVENWORTH LOOP | ||||||||
| Address2: | |||||||||
| City: | HAYDEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838350109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789836124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 W 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094743131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2019 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 60428 | ID | N | Nursing Service Providers | Registered Nurse | 163WN0002X | 61079183 | WA | N | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care | 163WN0002X | 60428 | ID | N | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care | 363LN0000X | AP61114357 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.