Healthcare Provider Details

I. General information

NPI: 1619986700
Provider Name (Legal Business Name): MICHELLE RAE PIEPER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 05/01/2008

III. Provider practice location address

5200 SOUTH 56TH SUITE 2
LINCOLN NE
68516
US

IV. Provider business mailing address

5200 SOUTH 56TH SUITE 2
LINCOLN NE
68516
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-6200
  • Fax:
Mailing address:
  • Phone: 402-421-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1223
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1223
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: