Provider Demographics
NPI:1346407236
Name:PIPPERT, BEVERLY C (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:C
Last Name:PIPPERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1243 TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:OOSTBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53070-1908
Mailing Address - Country:US
Mailing Address - Phone:920-564-3550
Mailing Address - Fax:
Practice Address - Street 1:W1243 TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:OOSTBURG
Practice Address - State:WI
Practice Address - Zip Code:53070-1908
Practice Address - Country:US
Practice Address - Phone:920-564-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI105409-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35056300Medicaid