Healthcare Provider Details

I. General information

NPI: 1336405166
Provider Name (Legal Business Name): JULIE GUENTHER TEBBEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 WILLOW LAKE BLVD SUITE 100
VADNAIS HEIGHTS MN
55110-5152
US

IV. Provider business mailing address

3485 WILLOW LAKE BLVD SUITE 100
VADNAIS HEIGHTS MN
55110-5152
US

V. Phone/Fax

Practice location:
  • Phone: 651-484-5567
  • Fax: 165-134-4440
Mailing address:
  • Phone: 651-484-5567
  • Fax: 165-134-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR119158-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: