Provider Demographics
NPI:1164195319
Name:ANDRESEN, JULIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 140TH ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:IA
Mailing Address - Zip Code:51018-8526
Mailing Address - Country:US
Mailing Address - Phone:712-229-2702
Mailing Address - Fax:
Practice Address - Street 1:700 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1601
Practice Address - Country:US
Practice Address - Phone:712-364-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA164758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily