Provider Demographics
NPI:1083426191
Name:PEPPER, WANDA (OWNER)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:PEPPER
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 THERESA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2236
Mailing Address - Country:US
Mailing Address - Phone:864-329-7033
Mailing Address - Fax:
Practice Address - Street 1:1200 WOODRUFF RD STE A3
Practice Address - Street 2:SUITE 190
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2960
Practice Address - Country:US
Practice Address - Phone:864-527-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty