Provider Demographics
NPI:1639550817
Name:LAROSE, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LAROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6442 CITY WEST PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3245
Mailing Address - Country:US
Mailing Address - Phone:763-318-2800
Mailing Address - Fax:763-318-2801
Practice Address - Street 1:6442 CITY WEST PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3245
Practice Address - Country:US
Practice Address - Phone:763-318-2800
Practice Address - Fax:763-318-2801
Is Sole Proprietor?:No
Enumeration Date:2015-06-14
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 3896363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner