Provider Demographics
NPI:1033443338
Name:FLIPSE, JERILYN M
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:M
Last Name:FLIPSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:OOSTBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53070-1455
Mailing Address - Country:US
Mailing Address - Phone:920-564-2398
Mailing Address - Fax:
Practice Address - Street 1:1011 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4006
Practice Address - Country:US
Practice Address - Phone:920-459-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4635-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist