Provider Demographics
NPI:1629601976
Name:LIPINSKI, RENEE COLLETTE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:COLLETTE
Last Name:LIPINSKI
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 1:7559 245TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4020
Mailing Address - Country:US
Mailing Address - Phone:763-229-1332
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2000
Practice Address - Country:US
Practice Address - Phone:763-229-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR143688163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR143688OtherNURSING LICENSE