Provider Demographics
NPI:1336554286
Name:LIPOVAC, MELISSA ANN (DNP ARNP FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:LIPOVAC
Suffix:
Gender:F
Credentials:DNP ARNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4607
Mailing Address - Fax:515-241-4633
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4607
Practice Address - Fax:515-241-4633
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117420163W00000X
IAA117420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI22140031Medicare PIN