=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831045665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GUY CARLAN LESCH JR. LPN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2026
-----------------------------------------------------
Last Update Date | 03/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 LUSITANO ST
-----------------------------------------------------
City | SHAKOPEE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55379-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-629-7109
-----------------------------------------------------
Fax | 612-467-1014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1555 LUSITANO ST
-----------------------------------------------------
City | SHAKOPEE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55379-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-629-7109
-----------------------------------------------------
Fax | 612-467-1014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | L055151-7
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------