Provider Demographics
NPI:1164661286
Name:PESHKE, KATHLEEN ANN (MS, RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:PESHKE
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GENESYS PARKWAY
Mailing Address - Street 2:GENESYS DIABETES LEARNING CENTER
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8066
Mailing Address - Country:US
Mailing Address - Phone:810-606-7720
Mailing Address - Fax:810-606-7747
Practice Address - Street 1:ONE GENESYS PARKWAY
Practice Address - Street 2:GENESYS DIABETES LEARNING CENTER
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8066
Practice Address - Country:US
Practice Address - Phone:810-606-7720
Practice Address - Fax:810-606-7747
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered