Provider Demographics
NPI:1144513110
Name:PIEPER, TRISHA JO (RN)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:JO
Last Name:PIEPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2789 CTY RD F
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010
Mailing Address - Country:US
Mailing Address - Phone:920-251-9000
Mailing Address - Fax:
Practice Address - Street 1:W2789 CTY RD F
Practice Address - Street 2:
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53010
Practice Address - Country:US
Practice Address - Phone:920-251-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI162104-30163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care