Healthcare Provider Details

I. General information

NPI: 1316732969
Provider Name (Legal Business Name): JULIE ANN WAGNER THOMPSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S SIBLEY AVE
LITCHFIELD MN
55355-3340
US

IV. Provider business mailing address

65309 295TH ST
LITCHFIELD MN
55355-4706
US

V. Phone/Fax

Practice location:
  • Phone: 320-693-4500
  • Fax:
Mailing address:
  • Phone: 320-444-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number12644
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: