Provider Demographics
NPI:1285830182
Name:HECKATHORNE, JULIE ANN (CNS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HECKATHORNE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:WOLTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS
Mailing Address - Street 1:6425 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1675
Mailing Address - Country:US
Mailing Address - Phone:612-861-1675
Mailing Address - Fax:612-861-3446
Practice Address - Street 1:6425 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-1675
Practice Address - Country:US
Practice Address - Phone:612-861-1675
Practice Address - Fax:612-861-3446
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 153123-5163WP0808X
MNR153123-5364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health