MEDICARE: MRS. JULIE ANN SUCH APRN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	R164182-4	MN
2	363LA2100X	Acute Care Nurse Practitioner	CNP 2617	MN

General Provider Information

NPI Number	:	1083923494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANN SUCH APRN, CNP

Provider Business Mailing Address
First Line	:	8170 33RD AVE S
Second Line	:	PO BOX 1309 MAIL STOP 21110Q
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	952-993-3230
Fax Number	:

Provider Business Practice Location Address
First Line	:	3931 LOUISIANA AVE S
Second Line	:	STE E400
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-5000
Country	:	US
Telephone Number	:	952-993-3230
Fax Number	:	952-993-1748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2010
Last Update Date	:	03/04/2016

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