Provider Demographics
NPI:1083780217
Name:LIPP, JANICE ELAINE (DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ELAINE
Last Name:LIPP
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515
Mailing Address - Country:US
Mailing Address - Phone:979-849-2447
Mailing Address - Fax:979-848-8337
Practice Address - Street 1:120 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:979-849-2447
Practice Address - Fax:979-848-8337
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered