Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71002887A | IN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 28159253A | IN |
NPI | 1003057027 |
---|---|
Provider Name | Mrs. Jamie Lynn Peppler |
First Address | Fort Wayne, IN 46814-4202 |
Second Address | Fort Wayne, IN 46814-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2009 |
Last Update Date | 04/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MP1932703 | DEA (01) | IN |