Provider Demographics
NPI:1578790416
Name:GAUDERMAN, JULIE C (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:GAUDERMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:13911 RIDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1771
Mailing Address - Country:US
Mailing Address - Phone:952-932-0998
Mailing Address - Fax:952-932-7122
Practice Address - Street 1:13911 RIDGEDALE DR
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:952-932-0998
Practice Address - Fax:952-932-7122
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2018-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR170263-7367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered