Provider Demographics
NPI:1831198613
Name:DIPPOLD, MARILYN ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ANN
Last Name:DIPPOLD
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 1:8890 N UNION BLVD
Mailing Address - Street 2:STE 165
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7799
Mailing Address - Country:US
Mailing Address - Phone:719-494-1950
Mailing Address - Fax:719-494-1940
Practice Address - Street 1:8890 N UNION BLVD
Practice Address - Street 2:STE 165
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7799
Practice Address - Country:US
Practice Address - Phone:719-494-1950
Practice Address - Fax:719-494-1940
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
C520018Medicare ID - Type Unspecified
S86899Medicare UPIN