Provider Demographics
NPI:1801687595
Name:TIPPA, NUSIRATU
Entity type:Individual
Prefix:
First Name:NUSIRATU
Middle Name:
Last Name:TIPPA
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 1:14 PHEASANTWOOD TER
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3862
Mailing Address - Country:US
Mailing Address - Phone:720-481-0803
Mailing Address - Fax:
Practice Address - Street 1:14 PHEASANTWOOD TER
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3862
Practice Address - Country:US
Practice Address - Phone:720-481-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10013347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse