Healthcare Provider Details

I. General information

NPI: 1346564721
Provider Name (Legal Business Name): STACEY LYNN PIPKIN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 BRIDGEPORT CIR
MAGALIA CA
95954-9637
US

IV. Provider business mailing address

14655 BRIDGEPORT CIR
MAGALIA CA
95954-9637
US

V. Phone/Fax

Practice location:
  • Phone: 530-327-7387
  • Fax:
Mailing address:
  • Phone: 530-327-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN229436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: