Provider Demographics
NPI:1366687261
Name:LIPPITT, PAMELA S (CNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:LIPPITT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 RILEY WILLS RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9037
Mailing Address - Country:US
Mailing Address - Phone:937-534-0155
Mailing Address - Fax:937-534-0166
Practice Address - Street 1:944 RILEY WILLS RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9037
Practice Address - Country:US
Practice Address - Phone:937-534-0155
Practice Address - Fax:937-534-0166
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10426-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner