Healthcare Provider Details

I. General information

NPI: 1487015996
Provider Name (Legal Business Name): JULE VANZANDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 WINNEBAGO AVE #3
FAIRMONT MN
56031-3645
US

IV. Provider business mailing address

40 MAIN ST E
TRIMONT MN
56176-9601
US

V. Phone/Fax

Practice location:
  • Phone: 507-235-5999
  • Fax:
Mailing address:
  • Phone: 218-220-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2152260
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: