Provider Demographics
NPI:1902875826
Name:KUCK, ANNETTE W (NP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:W
Last Name:KUCK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6025 LAKE RD
Mailing Address - Street 2:STE110
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1709
Mailing Address - Country:US
Mailing Address - Phone:651-735-7414
Mailing Address - Fax:651-735-1827
Practice Address - Street 1:6025 LAKE RD
Practice Address - Street 2:STE110
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1709
Practice Address - Country:US
Practice Address - Phone:651-735-7414
Practice Address - Fax:651-735-1827
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR089470-8363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34860000Medicaid
MNHP23673OtherHEALTHPARTNERS
MN1008767OtherAMERICA'S PPO
MN831022000Medicaid
MN0407370OtherMEDICA
MN132742OtherUCARE MN
MN1008767OtherAMERICA'S PPO
MN132742OtherUCARE MN