Provider Demographics
NPI:1346564721
Name:PIPKIN, STACEY LYNN (LVN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14655 BRIDGEPORT CIR
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-9637
Mailing Address - Country:US
Mailing Address - Phone:530-327-7387
Mailing Address - Fax:
Practice Address - Street 1:14655 BRIDGEPORT CIR
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-9637
Practice Address - Country:US
Practice Address - Phone:530-327-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN229436164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse