Provider Demographics
NPI:1689049405
Name:LIPPIATT, JAMIE DOLORES
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:DOLORES
Last Name:LIPPIATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:D
Other - Last Name:PAWLAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-1110
Mailing Address - Fax:577-874-1031
Practice Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:577-874-1031
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60446834163W00000X
CA785289163W00000X
AZ168374163W00000X
OK94938163W00000X
CO0196516163W00000X
OH345761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse