Basic Information
| Provider Information | |||||||||
| NPI: | 1548701733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPPERLY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 W 14TH AVE | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993374012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095281279 | ||||||||
| FaxNumber: | 5095462262 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 N 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993015257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095462203 | ||||||||
| FaxNumber: | 5095462262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 60094116 | WA | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.