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Individual

DEO M PEPPERSACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
217 W GEORGIA AVE STE 120, NAMPA, ID 83686-6812
(208) 498-1760
(208) 498-1761
Mailing address
217 W. GEORGIA AVE. STE 120, NAMPA, ID 83686-2856
(208) 498-1760
(208) 498-1769

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
NP656A
ID
363LF0000X
Family Nurse Practitioner
Primary
NP656A
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
NP656A
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
806976700
ID
05
8083269
ID
01
NP191
BLUE CROSS
ID
Enumeration date
05/24/2006
Last updated
03/18/2016
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