Healthcare Provider Details

I. General information

NPI: 1669612271
Provider Name (Legal Business Name): 5 PEPPERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W GEORGIA AVE STE 120
NAMPA ID
83686-6812
US

IV. Provider business mailing address

353 W IOWA AVE
NAMPA ID
83686-2856
US

V. Phone/Fax

Practice location:
  • Phone: 208-498-1760
  • Fax: 208-498-1769
Mailing address:
  • Phone: 208-498-1760
  • Fax: 208-498-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-27706
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number656A
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP656A
License Number StateID

VIII. Authorized Official

Name: MRS. DEO MARIE PEPPERSACK
Title or Position: OWNER
Credential: FNP
Phone: 208-498-1760