Provider Demographics
NPI:1033849252
Name:GEPPELT, CINNEAMON LEE (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:CINNEAMON
Middle Name:LEE
Last Name:GEPPELT
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:CINNEAMON
Other - Middle Name:LEE
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP STUDENT
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1408 POMERELLE AVE STE H
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2068
Practice Address - Country:US
Practice Address - Phone:208-677-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-11
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3671142367A00000X
UT10297351-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife