Healthcare Provider Details

I. General information

NPI: 1912892191
Provider Name (Legal Business Name): THOMAS NIPPER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 CUMMINS DR STE B
MODESTO CA
95358-6402
US

IV. Provider business mailing address

1581 CUMMINS DR STE B
MODESTO CA
95358-6402
US

V. Phone/Fax

Practice location:
  • Phone: 209-574-1605
  • Fax:
Mailing address:
  • Phone: 209-574-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number464108
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number464108
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number464108
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number464108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: