Provider Demographics
NPI:1720410681
Name:LESCHAK, KIM JO (LPN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:JO
Last Name:LESCHAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17230 NOOPIMING DR
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-4522
Mailing Address - Country:US
Mailing Address - Phone:320-532-7776
Mailing Address - Fax:320-532-7524
Practice Address - Street 1:17230 NOOPIMING DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-4522
Practice Address - Country:US
Practice Address - Phone:320-532-7776
Practice Address - Fax:320-532-7524
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 075091-0164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse