Provider Demographics
NPI:1093873028
Name:PIEPLOW, PHYLLIS ANN (PDN RN RCS)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:PIEPLOW
Suffix:
Gender:F
Credentials:PDN RN RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9922 HICKORY LANE
Mailing Address - Street 2:
Mailing Address - City:PICKETT
Mailing Address - State:WI
Mailing Address - Zip Code:54964
Mailing Address - Country:US
Mailing Address - Phone:920-589-4700
Mailing Address - Fax:
Practice Address - Street 1:2307 DOTY ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902
Practice Address - Country:US
Practice Address - Phone:920-651-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI78718 030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38271700Medicaid