Healthcare Provider Details

I. General information

NPI: 1871844852
Provider Name (Legal Business Name): DANA RENEE STIPP MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

121 FAIRFIELD DR
MT STERLING KY
40353-9385
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-281-4963
Mailing address:
  • Phone: 859-498-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1071706
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: