Basic Information
| Provider Information | |||||||||
| NPI: | 1063484343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUCZENSKI | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE S | ||||||||
| Address2: | MS21110Q | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528835375 | ||||||||
| FaxNumber: | 6515238584 | ||||||||
| Practice Location | |||||||||
| Address1: | 3930 NORTHWOODS DR - MAIL STOP 32800A | ||||||||
| Address2: | HEALTH PARTNERS ARDEN HILLS CLINIC | ||||||||
| City: | ARDEN HILLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551126974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6515238500 | ||||||||
| FaxNumber: | 6515238584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R1122275 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 284027800 | 05 | MN | MEDICAID |