Provider Demographics
NPI:1417361676
Name:NIPPES, LEITH (LAC)
Entity Type:Individual
Prefix:
First Name:LEITH
Middle Name:
Last Name:NIPPES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HIGHLAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3812
Mailing Address - Country:US
Mailing Address - Phone:978-893-6130
Mailing Address - Fax:
Practice Address - Street 1:18 HIGHLAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3812
Practice Address - Country:US
Practice Address - Phone:978-893-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 963171100000X
MA261146171100000X
NHACP 227171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist