Healthcare Provider Details

I. General information

NPI: 1063484343
Provider Name (Legal Business Name): JUDITH A KUCZENSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 NORTHWOODS DR - MAIL STOP 32800A HEALTH PARTNERS ARDEN HILLS CLINIC
ARDEN HILLS MN
55112-6974
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-523-8500
  • Fax: 651-523-8584
Mailing address:
  • Phone: 952-883-5375
  • Fax: 651-523-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1122275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: