Provider Demographics
NPI:1235960154
Name:GLUCK, LAURA KATHRYN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KATHRYN
Last Name:GLUCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:KATHRYN
Other - Last Name:TRUESCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:740 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:OAK VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:93022-9234
Mailing Address - Country:US
Mailing Address - Phone:443-799-6991
Mailing Address - Fax:
Practice Address - Street 1:740 THOMAS ST
Practice Address - Street 2:
Practice Address - City:OAK VIEW
Practice Address - State:CA
Practice Address - Zip Code:93022-9234
Practice Address - Country:US
Practice Address - Phone:443-799-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily