Provider Demographics
NPI:1518503176
Name:PIEPER, MARY JO
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:PIEPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DAYTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1526
Mailing Address - Country:US
Mailing Address - Phone:218-632-8493
Mailing Address - Fax:218-260-2727
Practice Address - Street 1:22 DAYTON AVE SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1526
Practice Address - Country:US
Practice Address - Phone:218-632-8493
Practice Address - Fax:218-260-2727
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR96529-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse