Provider Demographics
NPI:1811410871
Name:LAACK, JESSIE JEAN (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:JEAN
Last Name:LAACK
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LEWERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WASHOE VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89704-9527
Mailing Address - Country:US
Mailing Address - Phone:775-241-3616
Mailing Address - Fax:866-373-4398
Practice Address - Street 1:100 LEWERS CREEK RD
Practice Address - Street 2:
Practice Address - City:WASHOE VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89704-9527
Practice Address - Country:US
Practice Address - Phone:775-241-3616
Practice Address - Fax:866-373-4398
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily