Organization · NPI-2

5 Peppers INC.

Family Medicine · Nampa, ID

NPI number1669612271
StatusActive
Last updated in NPPESMar 9, 2016

Details

NPI
1669612271
Entity type
Organization (NPI-2)
Legal business name
5 Peppers INC.
Organization subpart
No
Enumeration date
Feb 23, 2009
Last updated
Mar 9, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes
363LP0808X Nurse Practitioner, Psych/Mental HealthNP656AID
1041C0700X Social Worker, ClinicalLMSW-27706ID
363LF0000X Nurse Practitioner, Family656AID

Other names

  • Dba Acacia Wellness Center (Doing Business As)

Practice location

217 W Georgia Ave Ste 120
Nampa, ID 83686-6812

Phone 208-498-1760 · Fax 208-498-1769

Mailing address

353 W Iowa Ave
Nampa, ID 83686-2856

Phone 208-498-1760 · Fax 208-498-1761

Authorized official

Deo Marie Peppersack
Owner
2084981760

Is something wrong?

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