Provider Demographics
NPI:1619986700
Name:PIEPER, MICHELLE RAE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RAE
Last Name:PIEPER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SOUTH 56TH
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-421-6200
Mailing Address - Fax:
Practice Address - Street 1:5200 SOUTH 56TH
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-421-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-05-01
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-05-01
Provider Licenses
StateLicense IDTaxonomies
NE1223363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ67491Medicare UPIN