Provider Demographics
NPI:1497478317
Name:HIPPERT, CAMEO LYSSA
Entity Type:Individual
Prefix:
First Name:CAMEO
Middle Name:LYSSA
Last Name:HIPPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S TULPEHOCKEN ST
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-1038
Mailing Address - Country:US
Mailing Address - Phone:570-691-8397
Mailing Address - Fax:
Practice Address - Street 1:100 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6132
Practice Address - Country:US
Practice Address - Phone:610-437-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN631204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse