Provider Demographics
NPI:1730400417
Name:MCQUOWN-PECH, TRACY L (BSN, RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:MCQUOWN-PECH
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W LIND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-4301
Mailing Address - Country:US
Mailing Address - Phone:507-386-0576
Mailing Address - Fax:
Practice Address - Street 1:200 W LIND ST
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-4301
Practice Address - Country:US
Practice Address - Phone:507-386-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN194321-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse