Provider Demographics
NPI:1760683460
Name:LIPPIE, BARBARA ELLEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ELLEN
Last Name:LIPPIE
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 1:25246 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CALUMET
Mailing Address - State:MI
Mailing Address - Zip Code:49913-1534
Mailing Address - Country:US
Mailing Address - Phone:906-337-2923
Mailing Address - Fax:
Practice Address - Street 1:56198 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-2358
Practice Address - Country:US
Practice Address - Phone:906-337-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703037134164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4948932OtherAUTHENTICARE