Provider Demographics
NPI:1679167399
Name:PIEPER, LAURA ANN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:PIEPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1831
Mailing Address - Country:US
Mailing Address - Phone:217-565-3160
Mailing Address - Fax:
Practice Address - Street 1:815 N LONG ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1172
Practice Address - Country:US
Practice Address - Phone:217-820-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty