Provider Demographics
NPI:1902893779
Name:NEPPLE, MICHELLE B (PAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:B
Last Name:NEPPLE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:B
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1717 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4543
Mailing Address - Country:US
Mailing Address - Phone:319-233-0340
Mailing Address - Fax:319-233-0666
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-233-0340
Practice Address - Fax:319-233-0666
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33583OtherWELLMARK BCBS
IA33583OtherWELLMARK BCBS
IAP00703809Medicare PIN
IAI10636Medicare PIN
P99788Medicare UPIN