Individual
MS. MAXINE LUECKENOTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
10 BARNES WEST DR, POB 2 STE 200, SAINT LOUIS, MO 63141-6287
(314) 996-3198
(314) 996-3087
Mailing address
660 S EUCLID AVE, C B 8127, SAINT LOUIS, MO 63110-1010
(314) 434-7775
(314) 454-5049
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
067290
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424805505
—
MO
05
—
ENROLLED
—
IL
Enumeration date
06/27/2006
Last updated
01/24/2018
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