Healthcare Provider Details

I. General information

NPI: 1144513110
Provider Name (Legal Business Name): TRISHA JO PIEPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W2789 CTY RD F
CAMPBELLSPORT WI
53010
US

IV. Provider business mailing address

W2789 CTY RD F
CAMPBELLSPORT WI
53010
US

V. Phone/Fax

Practice location:
  • Phone: 920-251-9000
  • Fax:
Mailing address:
  • Phone: 920-251-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number162104-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: