Provider Demographics
NPI:1003395641
Name:LIPTHRATT, MYUNGSUN (FNP)
Entity Type:Individual
Prefix:
First Name:MYUNGSUN
Middle Name:
Last Name:LIPTHRATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2503
Mailing Address - Country:US
Mailing Address - Phone:614-367-1654
Mailing Address - Fax:614-453-8222
Practice Address - Street 1:5245 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2503
Practice Address - Country:US
Practice Address - Phone:614-367-1654
Practice Address - Fax:614-453-8222
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily