Provider Demographics
NPI:1063836468
Name:KOVANDA, JULIE KRISTIN (APN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KRISTIN
Last Name:KOVANDA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2531
Mailing Address - Country:US
Mailing Address - Phone:737-284-2200
Mailing Address - Fax:
Practice Address - Street 1:3305 CENTRAL PARK VILLAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-7707
Practice Address - Country:US
Practice Address - Phone:651-406-8860
Practice Address - Fax:651-406-8860
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily