MEDICARE: JESSIE JEAN LAACK DNP, APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	APRN002582	NV

General Provider Information

NPI Number	:	1811410871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE JEAN LAACK DNP, APRN, FNP-C

Provider Business Mailing Address
First Line	:	100 LEWERS CREEK RD
Second Line	:
City	:	WASHOE VALLEY
State	:	NV
Zip	:	89704-9527
Country	:	US
Telephone Number	:	775-241-3616
Fax Number	:	866-373-4398

Provider Business Practice Location Address
First Line	:	100 LEWERS CREEK RD
Second Line	:
City	:	WASHOE VALLEY
State	:	NV
Zip	:	89704-9527
Country	:	US
Telephone Number	:	775-241-3616
Fax Number	:	866-373-4398

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

Provider Enumeration Date	:	07/21/2017
Last Update Date	:	05/30/2023

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