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General NPI Number Information
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NPI Number | 1922754134
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Entity Type | Individual
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Provider Name | JULI SUZANNE BLACK APRN, CNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 15088 22ND AVE NE STE 3
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3634
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Country | US
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Telephone | 320-429-7535
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Fax | 320-238-7528
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Provider Business Mailing Address
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Address Line | 32518 RIVER VISTA LN
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City | SAINT CLOUD
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State | MN
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Zip | 56303-9564
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Country | US
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Telephone | 320-429-7535
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Fax | 320-238-7528
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9026
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License Number State | MN
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