Basic Information
Provider Information
NPI: 1497947477
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEPPEL
FirstName: SARA
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2109 HUGHES DR
Address2: #220
City: TOLEDO
State: OH
PostalCode: 436063856
CountryCode: US
TelephoneNumber: 4192915150
FaxNumber: 4194796173
Practice Location
Address1: 2109 HUGHES DR
Address2: #220
City: TOLEDO
State: OH
PostalCode: 436063856
CountryCode: US
TelephoneNumber: 4192915150
FaxNumber: 4194796173
Other Information
ProviderEnumerationDate: 08/14/2007
LastUpdateDate: 10/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XCOA 08912-NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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