Provider Demographics
NPI:1669430245
Name:PEPPER, DEANNA T (RN, MSN, WHNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:T
Last Name:PEPPER
Suffix:
Gender:F
Credentials:RN, MSN, WHNP
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:T
Other - Last Name:MYERCHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40520 CTY HWY 34
Mailing Address - Street 2:WHITE EARTH INDIAN HEALTH SERVICE
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569-9612
Mailing Address - Country:US
Mailing Address - Phone:218-983-6212
Mailing Address - Fax:218-983-6369
Practice Address - Street 1:40520 CTY HWY 34
Practice Address - Street 2:WHITE EARTH INDIAN HEALTH SERVICE
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569-9612
Practice Address - Country:US
Practice Address - Phone:218-983-6212
Practice Address - Fax:218-983-6369
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1493548163W00000X, 163WG0000X, 163WP2201X
MNR-149354-8363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care