Provider Demographics
NPI:1891025839
Name:PEPPERS, SUZANNE M (PA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:PEPPERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:STE 101
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3494
Mailing Address - Country:US
Mailing Address - Phone:563-359-1646
Mailing Address - Fax:
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:STE 101
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3494
Practice Address - Country:US
Practice Address - Phone:563-359-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant