| Doctor Name: | JULIE LIDDICOAT |
| NPI Number: | 1003105602 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CHN |
| License Number: | 081001795RN |
| Business Practice Address: | 426 Sw Stark St 3rd Floor Portland, OR - 972042347 |
| Business Phone Number: | 5039883417 |
| Business Fax Number: | 5039883419 |
| Mailing Address: | 421 Sw Oak St, Ste. 210 PORTLAND |
| State: | OR |
| Postal Code: | 972041817 |
| Phone Number: | 5039883663 |
| Fax Number: | 5039884098 |
| NPI Enumeration Date: | 04/04/2011 |
| NPI Last Update Date: | 04/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 081001795RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |