Provider Demographics
NPI:1770368631
Name:NIEKAMP, JULIE (LAC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:NIEKAMP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7912 COUNTY ROAD F
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-5829
Mailing Address - Country:US
Mailing Address - Phone:651-278-3805
Mailing Address - Fax:
Practice Address - Street 1:1640 10TH AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9033
Practice Address - Country:US
Practice Address - Phone:651-278-3805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2026-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist