Provider Demographics
NPI:1114185717
Name:PATIPPE, IRENE DJANGO
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:DJANGO
Last Name:PATIPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:IRENE
Other - Middle Name:DJANGO
Other - Last Name:KWAKAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:45 HATFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2734
Mailing Address - Country:US
Mailing Address - Phone:845-628-0587
Mailing Address - Fax:845-628-0587
Practice Address - Street 1:45 HATFIELD RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2734
Practice Address - Country:US
Practice Address - Phone:845-628-0587
Practice Address - Fax:845-628-0587
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2907351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse