MEDICARE: JESSICA LUX RN, LSN, PHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	R-1356575	MN

General Provider Information

NPI Number	:	1154265981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LUX RN, LSN, PHN

Provider Business Mailing Address
First Line	:	360 COLBORNE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-3228
Country	:	US
Telephone Number	:	651-767-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 SNELLING AVE S
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-2447
Country	:	US
Telephone Number	:	651-888-7633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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