Provider Demographics
NPI:1588866255
Name:PESCHEL, GINA OROURKE (PAC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:OROURKE
Last Name:PESCHEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:OROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:675 WATER ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3063
Mailing Address - Country:US
Mailing Address - Phone:952-906-7855
Mailing Address - Fax:952-470-4523
Practice Address - Street 1:675 WATER ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3063
Practice Address - Country:US
Practice Address - Phone:952-906-7855
Practice Address - Fax:952-470-4523
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16686300Medicaid
MNQ24882Medicare UPIN