Provider Demographics
NPI:1093733768
Name:LUCK, JEANNE LOUISE (RN, MSN, CFNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:LOUISE
Last Name:LUCK
Suffix:
Gender:F
Credentials:RN, MSN, CFNP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:LOUISE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CFNP
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:8290 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1847
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR105398-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
134K1LUOtherBLUECROSS BLUESHIELD
114567OtherMEDICA
969991017871OtherPREFERREDONE
HP30388OtherHEALTHPARTNERS
123231E949OtherUCARE
MN941319700Medicaid
HP30388OtherHEALTHPARTNERS
969991017871OtherPREFERREDONE