Individual
JULIE L. WYNNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
505 NE 87TH AVE STE 301, VANCOUVER, WA 98664-1965
(360) 514-1854
(360) 514-6063
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
40815
AZ
208600000X
Surgery Physician
MD61046959
WA
2086S0102X
Surgical Critical Care Physician
40815
AZ
2086S0102X
Surgical Critical Care Physician
MC-2824
ID
2086S0102X
Surgical Critical Care Physician
MD61046959
WA
2086S0127X
Trauma Surgery Physician
40815
AZ
2086S0127X
Trauma Surgery Physician
Primary
61046959
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
349220
—
AZ
Enumeration date
02/27/2006
Last updated
07/22/2026
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