Provider Demographics
NPI:1083937866
Name:HIPP, TANYA VERONIKA (LPN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:VERONIKA
Last Name:HIPP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 S NICHOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-5719
Mailing Address - Country:US
Mailing Address - Phone:414-460-4738
Mailing Address - Fax:
Practice Address - Street 1:4424 S NICHOLSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-5719
Practice Address - Country:US
Practice Address - Phone:414-460-4738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34495-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse