Provider Demographics
NPI:1164629671
Name:LANDSIEDEL, JULIE K (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:LANDSIEDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6644
Mailing Address - Country:US
Mailing Address - Phone:012-200-4797
Mailing Address - Fax:
Practice Address - Street 1:1701 S 12TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6644
Practice Address - Country:US
Practice Address - Phone:701-220-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDR27304OtherLICENSE
NDR27304OtherLICENSE