Provider Demographics
NPI:1326884636
Name:SIPP, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:SIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3028
Mailing Address - Country:US
Mailing Address - Phone:214-718-1453
Mailing Address - Fax:
Practice Address - Street 1:506 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3028
Practice Address - Country:US
Practice Address - Phone:214-718-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142633164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse