Provider Demographics
NPI:1487279030
Name:KUOCH, PESEY
Entity type:Individual
Prefix:MS
First Name:PESEY
Middle Name:
Last Name:KUOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15401 LAKE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-1914
Mailing Address - Country:US
Mailing Address - Phone:612-666-8232
Mailing Address - Fax:
Practice Address - Street 1:15401 LAKE STREET EXT
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-1914
Practice Address - Country:US
Practice Address - Phone:612-666-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty