Healthcare Provider Details

I. General information

NPI: 1447030416
Provider Name (Legal Business Name): JOSHUA DAVID LIPPMANN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF CALIFORNIA BERKELEY 2222 BANCROFT WAY
BERKELEY CA
94720-0001
US

IV. Provider business mailing address

UNIVERSITY OF CALIFORNIA BERKELEY 2222 BANCROFT WAY
BERKELEY CA
94720-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-3188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number95233657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: