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General NPI Number Information
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NPI Number | 1871973370
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Entity Type | Individual
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Provider Name | JULIE MINIKOWSKI
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Gender | Female
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 207 MILWAUKEE AVENUE A
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City | WATERFORD
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State | WI
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Zip | 53185
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Country | US
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Telephone | 262-534-9040
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Fax | 262-534-9041
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Provider Business Mailing Address
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Address Line | 207A MILWAUKEE AVE
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City | WATERFORD
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State | WI
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Zip | 53185
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Country | US
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Telephone | 262-534-9040
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Fax | 262-534-9041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 47402169
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License Number State | WI
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