Provider Demographics
NPI:1205847472
Name:HEPP, CHERYL L (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:HEPP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:800 E 21ST ST
Mailing Address - Street 2:PAT FINANCIAL SERVICES
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1016
Mailing Address - Country:US
Mailing Address - Phone:605-322-2754
Mailing Address - Fax:605-322-2727
Practice Address - Street 1:800 E 21ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1016
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-322-2727
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR024222-0517367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150882200Medicaid
SD5753760Medicaid
SC460224743-57105-AE61OtherTRICARE
SDR024222OtherDAKOTACARE
MN253L8HEOtherMN BLUE CROSS PROV #
SD0040151OtherSD BLUE CROSS PROV #
IA0576595Medicaid
NE460224743-48Medicaid
MN150882200Medicaid
SD5753760Medicaid