Provider Demographics
NPI:1689176455
Name:SPENCER, JULIE C (APRN MN PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:SPENCER
Suffix:
Gender:F
Credentials:APRN MN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28210 HOPEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-5147
Mailing Address - Country:US
Mailing Address - Phone:076-679-3745
Mailing Address - Fax:
Practice Address - Street 1:1082 HIGHWAY 3 S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3088
Practice Address - Country:US
Practice Address - Phone:507-667-9374
Practice Address - Fax:877-863-8936
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5711363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty