Provider Demographics
NPI:1255635199
Name:JULANDER, MINDE
Entity type:Individual
Prefix:
First Name:MINDE
Middle Name:
Last Name:JULANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1703
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-1703
Mailing Address - Country:US
Mailing Address - Phone:307-886-5773
Mailing Address - Fax:307-886-5773
Practice Address - Street 1:144 E 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-886-5773
Practice Address - Fax:307-886-5773
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator