Provider Demographics
NPI:1063823953
Name:KATHERYN P TIPTON
Entity Type:Organization
Organization Name:KATHERYN P TIPTON
Other - Org Name:KATHERYN P MAWHINNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:KATHERYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWHINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CRNA
Authorized Official - Phone:642-171-4527
Mailing Address - Street 1:5900 SKYLAB RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2061
Mailing Address - Country:US
Mailing Address - Phone:642-171-4527
Mailing Address - Fax:
Practice Address - Street 1:5900 SKYLAB RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2061
Practice Address - Country:US
Practice Address - Phone:642-171-4527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital