Healthcare Provider Details

I. General information

NPI: 1164354627
Provider Name (Legal Business Name): JULIE ANNEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E 69TH ST
RICHFIELD MN
55423-2404
US

IV. Provider business mailing address

136 E 69TH ST
RICHFIELD MN
55423-2404
US

V. Phone/Fax

Practice location:
  • Phone: 612-741-0288
  • Fax:
Mailing address:
  • Phone: 612-741-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: