Provider Demographics
NPI:1891864955
Name:LIPKE, SUZANNE VERNON (RN, BC-ADM, CDE)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:VERNON
Last Name:LIPKE
Suffix:
Gender:F
Credentials:RN, BC-ADM, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31001-0698
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0698
Mailing Address - Country:US
Mailing Address - Phone:602-263-1511
Mailing Address - Fax:602-263-1619
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1511
Practice Address - Fax:602-263-1619
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 481106163WD0400X
CA2590364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist