Provider Demographics
NPI:1386419745
Name:RUOTOLO, JULIANNA
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:RUOTOLO
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 1:3818 SW 21ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6802
Mailing Address - Country:US
Mailing Address - Phone:541-548-2899
Mailing Address - Fax:
Practice Address - Street 1:3818 SW 21ST ST STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6802
Practice Address - Country:US
Practice Address - Phone:541-548-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR222430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant