Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP60292018 | WA |
NPI | 1235486713 |
---|---|
Provider Name | Ann Peppers |
First Address | Tacoma, WA 98431-1100 |
Second Address | Tacoma, WA 98431-1100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 14/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP60292018 | WA STATE DEPARTMENT OF HEALTH (01) | WA |