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NPI Code Detail

MEDICARE: 5 PEPPERS INC.

MEDICARE: 5 PEPPERS INC.
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerNP656AID
21041C0700XClinical Social WorkerLMSW-27706ID
3363LF0000XFamily Nurse Practitioner656AID
4207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669612271
Entity Type Code : Organization
Provider Name (Legal Business Name) : 5 PEPPERS INC.
Provider Business Mailing Address
First Line : 353 W IOWA AVE
Second Line :
City : NAMPA
State : ID
Zip : 83686-2856
Country : US
Telephone Number : 208-498-1760
Fax Number : 208-498-1761
Provider Business Practice Location Address
First Line : 217 W GEORGIA AVE STE 120
Second Line :
City : NAMPA
State : ID
Zip : 83686-6812
Country : US
Telephone Number : 208-498-1760
Fax Number : 208-498-1769
Authorized Official
Title or Position : OWNER
Name : MRS. DEO MARIE PEPPERSACK
Credential : FNP
Telephone Number : 208-498-1760
Provider Enumeration Date : 02/23/2009
Last Update Date : 03/09/2016

Similar Medicare Providers

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Practice Location Address:
217 W GEORGIA AVE STE 120
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1770538811 — DEO M PEPPERSACK NP
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1356358204 — GAERTNER CHIROPRACTIC & INTEGRATED MEDICINE CLINIC PA
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217 W GEORGIA AVE STE 120
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1639666811 — ROBERT EDWARD HADLEY LMSW
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217 W GEORGIA AVE STE 120
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Practice Location Address:
217 W GEORGIA AVE STE 120
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1417601840 — MCKENZIE MARY MORCOM CNP, PMHNP-BC
Practice Location Address:
217 W GEORGIA AVE STE 120
NAMPA, ID
83686-6812
Practice Phone: 208-498-1760
Practice Fax: 208-498-1769

Directions to “5 PEPPERS INC. ” Practice Location

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