Provider Demographics
NPI:1285179648
Name:SSEMPAKA, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SSEMPAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 WILLOW BROOKE DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-5264
Mailing Address - Country:US
Mailing Address - Phone:978-654-3463
Mailing Address - Fax:
Practice Address - Street 1:2111 WILLOW BROOKE DR APT 1A
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-5264
Practice Address - Country:US
Practice Address - Phone:978-654-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043118126164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse