Healthcare Provider Details

I. General information

NPI: 1144679044
Provider Name (Legal Business Name): RAYMOND LEWIS HIPPE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N CENTRAL AVE SUITE 1050
PHOENIX AZ
85004-1133
US

IV. Provider business mailing address

2700 N CENTRAL AVE SUITE 1050
PHOENIX AZ
85004-1133
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-8402
  • Fax: 602-264-0887
Mailing address:
  • Phone: 602-266-8402
  • Fax: 602-264-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8748
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: