Healthcare Provider Details

I. General information

NPI: 1285830182
Provider Name (Legal Business Name): JULIE ANN WOLTER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANN HECKATHORNE CNS

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 1ST ST E
JORDAN MN
55352-1502
US

IV. Provider business mailing address

981 WOODVIEW CIR
CARVER MN
55315-4519
US

V. Phone/Fax

Practice location:
  • Phone: 952-856-0522
  • Fax:
Mailing address:
  • Phone: 651-402-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number102
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR 153123-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: