Provider Demographics
NPI:1598930455
Name:DEAR-TACKER, LOUANNE MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:LOUANNE
Middle Name:MICHELLE
Last Name:DEAR-TACKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-8630
Mailing Address - Country:US
Mailing Address - Phone:320-846-0801
Mailing Address - Fax:
Practice Address - Street 1:222 9TH AVE W
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2221
Practice Address - Country:US
Practice Address - Phone:320-763-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-171099-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)