Provider Demographics
NPI:1184300519
Name:LIPPERT, MADISON ROSE (CNA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:LIPPERT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 JESSAMINE AVE
Mailing Address - Street 2:
Mailing Address - City:ANETA
Mailing Address - State:ND
Mailing Address - Zip Code:58212-4228
Mailing Address - Country:US
Mailing Address - Phone:701-270-8463
Mailing Address - Fax:
Practice Address - Street 1:521 JESSAMINE AVE
Practice Address - Street 2:
Practice Address - City:ANETA
Practice Address - State:ND
Practice Address - Zip Code:58212-4228
Practice Address - Country:US
Practice Address - Phone:701-270-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant