Healthcare Provider Details

I. General information

NPI: 1053540112
Provider Name (Legal Business Name): JULIE SKOVRAN MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20170 HUNTINGTON WAY
PRIOR LAKE MN
55372-9725
US

IV. Provider business mailing address

20170 HUNTINGTON WAY
PRIOR LAKE MN
55372-9725
US

V. Phone/Fax

Practice location:
  • Phone: 612-839-2328
  • Fax:
Mailing address:
  • Phone: 612-839-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: