Healthcare Provider Details

I. General information

NPI: 1053432997
Provider Name (Legal Business Name): MILDRED PEPPLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 S 84TH ST
PAPILLION NE
68046-4122
US

IV. Provider business mailing address

PO BOX 642117
OMAHA NE
68164-8117
US

V. Phone/Fax

Practice location:
  • Phone: 402-593-3131
  • Fax: 402-593-3117
Mailing address:
  • Phone: 402-717-4377
  • Fax: 402-717-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110838
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: