1700926342 NPI number — MRS. KATHRYN ANN LIPARI R.D., C.D.

Table of content: MRS. KATHRYN ANN LIPARI R.D., C.D. (NPI 1700926342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700926342 NPI number — MRS. KATHRYN ANN LIPARI R.D., C.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPARI
Provider First Name:
KATHRYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D., C.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALKER
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700926342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10737 HENDRICKS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWN POINT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46307-2926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-661-1769
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 S LAKE PARK AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-6790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-947-6122
Provider Business Practice Location Address Fax Number:
219-947-6045
Provider Enumeration Date:
02/06/2007

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: 133V00000X , with the licence number:  37001630A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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