Provider Demographics
NPI:1124577663
Name:SIPES, MARTY A (ST)
Entity Type:Individual
Prefix:MS
First Name:MARTY
Middle Name:A
Last Name:SIPES
Suffix:
Gender:F
Credentials:ST
Other - Prefix:MS
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:LARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:11704 W CENTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4327
Mailing Address - Country:US
Mailing Address - Phone:402-691-0500
Mailing Address - Fax:402-691-1586
Practice Address - Street 1:11704 W CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4327
Practice Address - Country:US
Practice Address - Phone:402-691-0500
Practice Address - Fax:402-691-1586
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist