Healthcare Provider Details

I. General information

NPI: 1013029263
Provider Name (Legal Business Name): JULIE A VANECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5366 386TH ST NE
NORTH BRANCH MN
55056-5833
US

IV. Provider business mailing address

5366 386TH ST NE
NORTH BRANCH MN
55056-5833
US

V. Phone/Fax

Practice location:
  • Phone: 651-674-8353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40831
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: