Provider Demographics
NPI:1710958418
Name:PEPE, JOANNE WADE (CNM)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:WADE
Last Name:PEPE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-773-5729
Mailing Address - Fax:518-775-4118
Practice Address - Street 1:4104 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-6202
Practice Address - Country:US
Practice Address - Phone:518-883-8634
Practice Address - Fax:518-883-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000446367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY995013OtherMVP HEALTHPLAN
NY000406761006OtherBSH NE NY
NY01281103Medicaid
NY01281103Medicaid