Individual
JULIE ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3230
(952) 993-1748
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2564
MN
363LA2200X
Adult Health Nurse Practitioner
2006007942
MN
363LA2200X
Adult Health Nurse Practitioner
2564
MN
Other
Enumeration date
01/22/2007
Last updated
02/23/2024
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