Healthcare Provider Details

I. General information

NPI: 1437146826
Provider Name (Legal Business Name): PATRICIA ANN PESCHMAN RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12755 HIGHWAY 55 MN009-S130
PLYMOUTH MN
55441-3837
US

IV. Provider business mailing address

1104 WHITNEY DR
APPLE VALLEY MN
55124-9142
US

V. Phone/Fax

Practice location:
  • Phone: 800-896-8936
  • Fax: 763-797-4075
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR0882260
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: