Provider Demographics
NPI:1285830182
Name:WOLTER, JULIE ANN (CNS)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:WOLTER
Suffix:
Gender:
Credentials:CNS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HECKATHORNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS
Mailing Address - Street 1:981 WOODVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-4519
Mailing Address - Country:US
Mailing Address - Phone:651-402-3648
Mailing Address - Fax:
Practice Address - Street 1:110 1ST ST E
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1502
Practice Address - Country:US
Practice Address - Phone:952-856-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102364SP0809X
MNR 153123-5163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health