Provider Demographics
NPI:1316300874
Name:ATANGA, JULIANA WIRKPU (R N)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:WIRKPU
Last Name:ATANGA
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:WIRKPU
Other - Last Name:KINDZEKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4105 85TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2054
Mailing Address - Country:US
Mailing Address - Phone:763-634-5994
Mailing Address - Fax:
Practice Address - Street 1:801 101ST LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2678
Practice Address - Country:US
Practice Address - Phone:763-780-9603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN227060-5163W00000X
MNL058567-7164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse