Provider Demographics
NPI:1407966997
Name:PHIPPS, ALICE M (CNM, NP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 N BOYD WAY
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3214
Mailing Address - Country:US
Mailing Address - Phone:414-202-6604
Mailing Address - Fax:414-540-6881
Practice Address - Street 1:530 N 108TH PL STE 100
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4253
Practice Address - Country:US
Practice Address - Phone:414-231-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137177367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39909600Medicaid
WIS36045Medicare UPIN
WI01715Medicare ID - Type Unspecified