Provider Demographics
NPI:1275102568
Name:SUCKOW, KASEY C (APRN)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:C
Last Name:SUCKOW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:C
Other - Last Name:TUFTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-0904
Mailing Address - Country:US
Mailing Address - Phone:651-380-6590
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-594-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily