Active NPI
Julie A. Vickerman, RN
- Nephrology Physician
- Saint Cloud, MN
National Provider Identifier
1518237676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- R-118625-3
- Practice address
- 1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735 - Phone
- (320) 252-5131
- NPI assigned
- Jan 6, 2012
- Last updated
- Jan 6, 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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | R-118625-3 | MN | Primary |
Addresses
Primary practice location
1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735
Mailing address
1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735
Phone (320) 252-5131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-118625-3 | MN | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1518237676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 SIXTH AVE N",
"address_2": "CENTRACARE CLINIC",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563032735",
"telephone_number": "320-252-5131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 SIXTH AVE N",
"address_2": "CENTRACARE CLINIC",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563032735",
"telephone_number": "320-252-5131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICKERMAN",
"first_name": "JULIE",
"middle_name": "A.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-06",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "MN",
"license": "R-118625-3",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.