Provider Demographics
NPI:1972849362
Name:LIPA, JALIE MOWRY (NP-BC, CRNA)
Entity Type:Individual
Prefix:
First Name:JALIE
Middle Name:MOWRY
Last Name:LIPA
Suffix:
Gender:F
Credentials:NP-BC, CRNA
Other - Prefix:
Other - First Name:JALIE
Other - Middle Name:J
Other - Last Name:MOWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-BC, CRNA
Mailing Address - Street 1:2431 RED APPLE RD
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9675
Mailing Address - Country:US
Mailing Address - Phone:513-374-2280
Mailing Address - Fax:
Practice Address - Street 1:50 FILER ST STE 210K
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2787
Practice Address - Country:US
Practice Address - Phone:231-299-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232682367500000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered