Provider Demographics
NPI:1407071848
Name:RIPPERGER, JUDITH A (PAC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:RIPPERGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IN
Mailing Address - Zip Code:46792-9277
Mailing Address - Country:US
Mailing Address - Phone:260-375-2965
Mailing Address - Fax:260-375-2969
Practice Address - Street 1:824 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792-9277
Practice Address - Country:US
Practice Address - Phone:260-375-2965
Practice Address - Fax:260-375-2969
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000347A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00758917OtherRAILROAD MEDICARE
IN234760PMedicare PIN
INP00758917OtherRAILROAD MEDICARE