Provider Demographics
NPI:1619055662
Name:SCHEPP, LAVERN K (PA)
Entity Type:Individual
Prefix:MR
First Name:LAVERN
Middle Name:K
Last Name:SCHEPP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:602-265-8338
Mailing Address - Fax:602-265-8574
Practice Address - Street 1:1424 S 7TH AVE BLDG C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3902
Practice Address - Country:US
Practice Address - Phone:602-258-3600
Practice Address - Fax:602-256-0514
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ638554Medicaid
Q64845Medicare UPIN
Z103835Medicare PIN