Provider Demographics
NPI:1033553185
Name:POWERS-PEPRAH, PAULINE ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:ELIZABETH
Last Name:POWERS-PEPRAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:ELIZABETH
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:29 BLACK COLE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514
Mailing Address - Country:US
Mailing Address - Phone:307-332-7300
Mailing Address - Fax:
Practice Address - Street 1:29 BLACK COLE
Practice Address - Street 2:
Practice Address - City:FORT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514
Practice Address - Country:US
Practice Address - Phone:307-332-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10660A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine