1689049405 NPI number — MS. JAMIE DOLORES LIPPIATT

Table of content: MS. JAMIE DOLORES LIPPIATT (NPI 1689049405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689049405 NPI number — MS. JAMIE DOLORES LIPPIATT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPPIATT
Provider First Name:
JAMIE
Provider Middle Name:
DOLORES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAWLAK
Provider Other First Name:
JAMIE
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689049405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9040 REID STREET, ATTN: MCHJ-CLQ-C
Provider Second Line Business Mailing Address:
MADIGAN ARMY MEDICAL CENTER
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-1110
Provider Business Mailing Address Fax Number:
577-874-1031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9040 REID STREET, ATTN: MCHJ-CLQ-C
Provider Second Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-1110
Provider Business Practice Location Address Fax Number:
577-874-1031
Provider Enumeration Date:
12/04/2015

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: 163W00000X , with the licence number:  60446834 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 785289 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 168374 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 94938 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 0196516 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 345761 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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