MEDICARE: MRS. VIRGINIA R JEPPESEN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP-1149A	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP-1149A	OTHER	ID	NURSE PRACTITIONER LICENSE
2	NUR-APRN-LIC-136599	OTHER	MT	NURSE PRACTITIONER LICENSE

General Provider Information

NPI Number	:	1174896419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA R JEPPESEN NP-C

Provider Business Mailing Address
First Line	:	536 S COTTONWOOD RD
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-9515
Country	:	US
Telephone Number	:	406-586-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 S COTTONWOOD RD
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-9515
Country	:	US
Telephone Number	:	406-586-8029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	11/25/2020

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