Healthcare Provider Details

I. General information

NPI: 1174435622
Provider Name (Legal Business Name): MICHELLE PIPPERT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25227 S SAINT RUBEN CT
QUEEN CREEK AZ
85142-2070
US

IV. Provider business mailing address

25227 S SAINT RUBEN CT
QUEEN CREEK AZ
85142-2070
US

V. Phone/Fax

Practice location:
  • Phone: 503-475-2551
  • Fax:
Mailing address:
  • Phone: 503-475-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number61546833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: