Provider Demographics
NPI:1124318902
Name:LASANEN, JACQUELINE ANN (LPN)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:ANN
Last Name:LASANEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 3RD ST SW APT 203
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-9643
Mailing Address - Country:US
Mailing Address - Phone:320-420-1366
Mailing Address - Fax:
Practice Address - Street 1:260 3RD ST SW APT 203
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-9643
Practice Address - Country:US
Practice Address - Phone:320-420-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 068167-8164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse