Healthcare Provider Details

I. General information

NPI: 1356022263
Provider Name (Legal Business Name): VIRGINIA D PIPPIN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAIN DR
FAYETTEVILLE AR
72704-5292
US

IV. Provider business mailing address

37 LANCASTER DR
BELLA VISTA AR
72715-5329
US

V. Phone/Fax

Practice location:
  • Phone: 479-485-1215
  • Fax:
Mailing address:
  • Phone: 337-207-5179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL-311049
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: