Healthcare Provider Details

I. General information

NPI: 1700461282
Provider Name (Legal Business Name): SAMANTHA HEPP AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ILLINOIS AVE
STEVENS POINT WI
54481-3114
US

IV. Provider business mailing address

6165 COUNTY ROAD BB
BANCROFT WI
54921-9735
US

V. Phone/Fax

Practice location:
  • Phone: 715-342-7765
  • Fax:
Mailing address:
  • Phone: 715-303-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10806-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: