Provider Demographics
NPI:1396335592
Name:PESCHKE, LAURA (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PESCHKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:OH
Mailing Address - Zip Code:44086-9808
Mailing Address - Country:US
Mailing Address - Phone:440-725-7420
Mailing Address - Fax:
Practice Address - Street 1:7050 DEWEY RD
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:OH
Practice Address - Zip Code:44086-9808
Practice Address - Country:US
Practice Address - Phone:440-725-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH362344163WH1000X, 174200000X, 251G00000X, 177F00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care