Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 61218 | MN |
Y | 207VX0201X | Gynecologic Oncologist | 61218 | MN |
NPI | 1013159029 |
---|---|
Provider Name | Jessica Ann Thomes Pepin |
First Address | Woodbury, MN 55125-1709 |
Second Address | Woodbury, MN 55125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 25/06/2018 |