Provider Demographics
NPI:1871973370
Name:MINIKOWSKI, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MINIKOWSKI
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 1:207A MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185
Mailing Address - Country:US
Mailing Address - Phone:262-534-9040
Mailing Address - Fax:262-534-9041
Practice Address - Street 1:207 MILWAUKEE AVENUE
Practice Address - Street 2:A
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185
Practice Address - Country:US
Practice Address - Phone:262-534-9040
Practice Address - Fax:262-534-9041
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47402169172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI47402169OtherCOMMUNITY CARE