Provider Demographics
NPI:1275516114
Name:DIPMAN HAM, STACY KAY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:KAY
Last Name:DIPMAN HAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:KAY
Other - Last Name:DIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2200 SW 6TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:2200 SW 6TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1707
Practice Address - Country:US
Practice Address - Phone:785-354-8518
Practice Address - Fax:785-354-1255
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43-556869367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN