1679298376 NPI number — KELLY IRENE LIPINSKI CASE MANAGEMENT

Table of content: KELLY IRENE LIPINSKI CASE MANAGEMENT (NPI 1679298376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679298376 NPI number — KELLY IRENE LIPINSKI CASE MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPINSKI
Provider First Name:
KELLY
Provider Middle Name:
IRENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CASE MANAGEMENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNHAM
Provider Other First Name:
KELLY
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CASE MANAGEMENT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679298376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 E TUDOR RD STE 9A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99507-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-409-9104
Provider Business Mailing Address Fax Number:
907-931-7087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 E TUDOR RD STE 9A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99507-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-409-9104
Provider Business Practice Location Address Fax Number:
907-931-7087
Provider Enumeration Date:
10/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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