Provider Demographics
NPI:1851316525
Name:ARNTSON, LUCIANA TAVARES (ANP)
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:TAVARES
Last Name:ARNTSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 IOWA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2241
Mailing Address - Country:US
Mailing Address - Phone:612-518-9768
Mailing Address - Fax:
Practice Address - Street 1:590 PARK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1846
Practice Address - Country:US
Practice Address - Phone:651-225-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR117925-7363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health