Provider Demographics
NPI:1841269362
Name:LIPSCHUTZ, ANGELA A (APNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:LIPSCHUTZ
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72780 COUNTRY CLUB DR STE A103
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4150
Mailing Address - Country:US
Mailing Address - Phone:760-779-5511
Mailing Address - Fax:760-773-3320
Practice Address - Street 1:72780 COUNTRY CLUB DR STE A103
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-779-5511
Practice Address - Fax:760-773-3320
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI202281-030363LX0001X
CA22359363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43837100Medicaid
WIP29947Medicare UPIN