Healthcare Provider Details

I. General information

NPI: 1811027055
Provider Name (Legal Business Name): JEFFREY PAUL LEPPERT RN APN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 BENNETT AVE
MEDFORD OR
97504-6715
US

IV. Provider business mailing address

825 BENNETT AVE
MEDFORD OR
97504-6715
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-5228
  • Fax: 541-772-1533
Mailing address:
  • Phone: 541-779-5228
  • Fax: 541-772-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number26NR11867300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00142100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60120714
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9261574
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201050041NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: