Healthcare Provider Details

I. General information

NPI: 1205273281
Provider Name (Legal Business Name): DEBRA SUE TIPPIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 FAST ICE DR
MIDLAND MI
48642-6167
US

IV. Provider business mailing address

3695 N SADLER DR
SANFORD MI
48657-9331
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-2320
  • Fax: 989-631-9903
Mailing address:
  • Phone: 517-262-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704149621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: