Healthcare Provider Details

I. General information

NPI: 1811410871
Provider Name (Legal Business Name): JESSIE JEAN LAACK DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEWERS CREEK RD
WASHOE VALLEY NV
89704-9527
US

IV. Provider business mailing address

100 LEWERS CREEK RD
WASHOE VALLEY NV
89704-9527
US

V. Phone/Fax

Practice location:
  • Phone: 775-241-3616
  • Fax: 866-373-4398
Mailing address:
  • Phone: 775-241-3616
  • Fax: 866-373-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002582
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: