Active NPI
Julie Guenther Tebben, CNP
- Women's Health Nurse Practitioner
- Vadnais Heights, MN
National Provider Identifier
1336405166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- R119158-1
- Practice address
- 3485 Willow Lake Blvd
Suite 100
Vadnais Heights, MN 55110-5152 - Phone
- (651) 484-5567
- Fax
- (165) 134-4440
- NPI assigned
- Apr 5, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | R119158-1 | MN | Primary |
Addresses
Primary practice location
3485 Willow Lake Blvd
Suite 100
Vadnais Heights, MN 55110-5152
Mailing address
3485 Willow Lake Blvd
Suite 100
Vadnais Heights, MN 55110-5152
Phone (651) 484-5567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Previously, effective Aug 12, 2014 through Aug 12, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R119158-1 | MN | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1333584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333584000000",
"number": "1336405166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3485 WILLOW LAKE BLVD",
"address_2": "SUITE 100",
"city": "VADNAIS HEIGHTS",
"state": "MN",
"postal_code": "551105152",
"telephone_number": "651-484-5567",
"fax_number": "165-134-4440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3485 WILLOW LAKE BLVD",
"address_2": "SUITE 100",
"city": "VADNAIS HEIGHTS",
"state": "MN",
"postal_code": "551105152",
"telephone_number": "651-484-5567",
"fax_number": "165-134-4440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEBBEN",
"first_name": "JULIE",
"middle_name": "GUENTHER",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-05",
"last_updated": "2012-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "MN",
"license": "R119158-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vadnais Heights, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.