Provider Demographics
NPI:1023824521
Name:MITTLEIDER, JULIE RENEE (LPN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:RENEE
Last Name:MITTLEIDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 20TH ST SW STE 8
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-6208
Mailing Address - Country:US
Mailing Address - Phone:701-952-4787
Mailing Address - Fax:
Practice Address - Street 1:2430 20TH ST SW STE 8
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-6208
Practice Address - Country:US
Practice Address - Phone:701-952-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL8014164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse