MEDICARE: DERRI LEPESKA BSN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	247621-30	WI

General Provider Information

NPI Number	:	1598412157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRI LEPESKA BSN RN

Provider Business Mailing Address
First Line	:	405 E MAPLE ST
Second Line	:
City	:	MONTFORT
State	:	WI
Zip	:	53569-9738
Country	:	US
Telephone Number	:	773-220-1496
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 E MAPLE ST
Second Line	:
City	:	MONTFORT
State	:	WI
Zip	:	53569-9738
Country	:	US
Telephone Number	:	773-220-1496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	03/03/2022

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