Provider Demographics
NPI:1437490331
Name:PIEPENBROK, JEWLIE MARIE (STNA)
Entity Type:Individual
Prefix:
First Name:JEWLIE
Middle Name:MARIE
Last Name:PIEPENBROK
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MARINERS CIR APT C
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-3002
Mailing Address - Country:US
Mailing Address - Phone:419-706-1997
Mailing Address - Fax:
Practice Address - Street 1:215 MARINERS CIR APT C
Practice Address - Street 2:
Practice Address - City:SHEFFIELD LAKE
Practice Address - State:OH
Practice Address - Zip Code:44054-3002
Practice Address - Country:US
Practice Address - Phone:419-706-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401370280312376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide