Provider Demographics
NPI:1073602207
Name:PEPPENGER, TAMMY (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PEPPENGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 UNIVERSITY OF OREGON
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1205
Mailing Address - Country:US
Mailing Address - Phone:541-346-2770
Mailing Address - Fax:
Practice Address - Street 1:1232 UNIVERSITY OF OREGON
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403
Practice Address - Country:US
Practice Address - Phone:541-346-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19903363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q41247Medicare UPIN