1851378525 NPI number — MS. MINDY J LIPSON RN/NP

Table of content: MS. MINDY J LIPSON RN/NP (NPI 1851378525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851378525 NPI number — MS. MINDY J LIPSON RN/NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPSON
Provider First Name:
MINDY
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN/NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOBSON
Provider Other First Name:
MINDY
Provider Other Middle Name:
NMN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, MSN, PNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851378525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5293 S ANGELA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-761-0422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5293 S ANGELA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-761-0422
Provider Business Practice Location Address Fax Number:
901-683-8700
Provider Enumeration Date:
12/23/2005

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: 363LP0200X , with the licence number:  60214 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 149326758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99423 . This is a "BCBS AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: QNP019 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3349720 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 425861101 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1138321 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00126536 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200390060A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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