Provider Demographics
NPI:1841254596
Name:ZIPPRICH, JENNY A (RN MSN CS)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:A
Last Name:ZIPPRICH
Suffix:
Gender:F
Credentials:RN MSN CS
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Other - Credentials:
Mailing Address - Street 1:3691 RUTGER AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-977-6828
Mailing Address - Fax:314-977-6777
Practice Address - Street 1:3660 VISTA
Practice Address - Street 2:1034 S BRENTWOOD
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-726-1612
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO108018163W00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425071503Medicaid