Provider Demographics
NPI:1417115312
Name:PRIEPKE, OWEN JOSEPH (RN, BSN)
Entity Type:Individual
Prefix:MR
First Name:OWEN
Middle Name:JOSEPH
Last Name:PRIEPKE
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-3502
Mailing Address - Country:US
Mailing Address - Phone:920-533-1100
Mailing Address - Fax:920-533-1148
Practice Address - Street 1:526 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53010-3502
Practice Address - Country:US
Practice Address - Phone:920-533-1100
Practice Address - Fax:920-533-1148
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131601-030163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology