Healthcare Provider Details

I. General information

NPI: 1477982585
Provider Name (Legal Business Name): JULIE NIEDFELDT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE BARTLETT

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MCHENRY ST
BURLINGTON WI
53105-1828
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-6100
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number157273-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209011022
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5999-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: