Provider Demographics
NPI:1255137733
Name:WADENA, JULIE M (RN, BSN, SANE-P)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:WADENA
Suffix:
Gender:
Credentials:RN, BSN, SANE-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24582 370TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUBUN
Mailing Address - State:MN
Mailing Address - Zip Code:56589-9399
Mailing Address - Country:US
Mailing Address - Phone:218-261-3280
Mailing Address - Fax:
Practice Address - Street 1:3078 WORKFORCE CENTER RD.
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557
Practice Address - Country:US
Practice Address - Phone:218-935-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2502950163WP0807X
MN35475163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent