Provider Demographics
NPI:1134833940
Name:LIPTON, JEAN-PAUL
Entity type:Individual
Prefix:MR
First Name:JEAN-PAUL
Middle Name:
Last Name:LIPTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-4104
Mailing Address - Country:US
Mailing Address - Phone:651-336-2404
Mailing Address - Fax:
Practice Address - Street 1:1324 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-4104
Practice Address - Country:US
Practice Address - Phone:651-336-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA698657500OtherMINNESOTA DEPARTMENT OF HUMAN SERVICES