Provider Demographics
NPI:1093374084
Name:PIEPER, JORDYN DEAN (PA-C)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:DEAN
Last Name:PIEPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8860 CATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOYAL
Mailing Address - State:WI
Mailing Address - Zip Code:54446-9706
Mailing Address - Country:US
Mailing Address - Phone:715-937-5200
Mailing Address - Fax:
Practice Address - Street 1:216 SUNSET PL
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1706
Practice Address - Country:US
Practice Address - Phone:715-743-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIPENDING207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine