Provider Demographics
NPI:1316967615
Name:JEPSON, LORI A (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:JEPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1058 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-9112
Mailing Address - Country:US
Mailing Address - Phone:701-627-4750
Mailing Address - Fax:
Practice Address - Street 1:1058 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-9112
Practice Address - Country:US
Practice Address - Phone:701-627-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner