Provider Demographics
NPI:1619343431
Name:PIPPEN, EMANI NAHCHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:EMANI
Middle Name:NAHCHELLE
Last Name:PIPPEN
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 1:10326 LANARK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1231
Mailing Address - Country:US
Mailing Address - Phone:313-909-2046
Mailing Address - Fax:313-647-4413
Practice Address - Street 1:10326 LANARK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1231
Practice Address - Country:US
Practice Address - Phone:313-909-2046
Practice Address - Fax:313-647-4413
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-16
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703101717311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home