Healthcare Provider Details

I. General information

NPI: 1174896419
Provider Name (Legal Business Name): VIRGINIA R JEPPESEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 S COTTONWOOD RD
BOZEMAN MT
59718-9515
US

IV. Provider business mailing address

536 S COTTONWOOD RD
BOZEMAN MT
59718-9515
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-8029
  • Fax:
Mailing address:
  • Phone: 406-586-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1149A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: