Provider Demographics
NPI:1700461282
Name:HEPP, SAMANTHA (AGPCNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HEPP
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6165 COUNTY ROAD BB
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:WI
Mailing Address - Zip Code:54921-9735
Mailing Address - Country:US
Mailing Address - Phone:715-303-8951
Mailing Address - Fax:
Practice Address - Street 1:900 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3114
Practice Address - Country:US
Practice Address - Phone:715-342-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10806-30363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner