Provider Demographics
NPI:1700849932
Name:LEPPERT, ROBERT J (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:LEPPERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 IRONWOOD PL
Mailing Address - Street 2:STE B
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2662
Mailing Address - Country:US
Mailing Address - Phone:208-665-1664
Mailing Address - Fax:
Practice Address - Street 1:1705 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3444
Practice Address - Country:US
Practice Address - Phone:208-765-8585
Practice Address - Fax:208-765-8486
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA537367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806597400Medicaid