Provider Demographics
NPI:1598412157
Name:LEPESKA, DERRI (BSN RN)
Entity Type:Individual
Prefix:
First Name:DERRI
Middle Name:
Last Name:LEPESKA
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MONTFORT
Mailing Address - State:WI
Mailing Address - Zip Code:53569-9738
Mailing Address - Country:US
Mailing Address - Phone:773-220-1496
Mailing Address - Fax:
Practice Address - Street 1:405 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:MONTFORT
Practice Address - State:WI
Practice Address - Zip Code:53569-9738
Practice Address - Country:US
Practice Address - Phone:773-220-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI247621-30163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management