Healthcare Provider Details

I. General information

NPI: 1093893927
Provider Name (Legal Business Name): JOHANNA C LIPPERT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 N 31ST AVE
PHOENIX AZ
85051-9562
US

IV. Provider business mailing address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-2233
  • Fax: 602-997-2667
Mailing address:
  • Phone: 602-265-8338
  • Fax: 602-265-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN062405
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: