Provider Demographics
NPI:1508587015
Name:IPPOLITO, LISSETTE ANNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LISSETTE
Middle Name:ANNE
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SWEETGUM LN
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3009
Mailing Address - Country:US
Mailing Address - Phone:631-357-0488
Mailing Address - Fax:
Practice Address - Street 1:78 SWEETGUM LN
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3009
Practice Address - Country:US
Practice Address - Phone:631-357-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse