Provider Demographics
NPI:1669884458
Name:LIPAN, MIRELA LISA (NP)
Entity type:Individual
Prefix:
First Name:MIRELA
Middle Name:LISA
Last Name:LIPAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 166TH ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2242
Mailing Address - Country:US
Mailing Address - Phone:718-801-6906
Mailing Address - Fax:
Practice Address - Street 1:1034 166TH ST APT 4D
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2242
Practice Address - Country:US
Practice Address - Phone:718-801-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654235163W00000X
NY343508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse