Provider Demographics
NPI:1457549560
Name:GLUECKERT, JACQUE RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JACQUE
Middle Name:RENEE
Last Name:GLUECKERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 PHEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-7111
Mailing Address - Country:US
Mailing Address - Phone:937-520-8527
Mailing Address - Fax:937-233-3726
Practice Address - Street 1:6507 PHEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-7111
Practice Address - Country:US
Practice Address - Phone:937-520-8527
Practice Address - Fax:937-233-3726
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN081148164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse