Healthcare Provider Details

I. General information

NPI: 1619260833
Provider Name (Legal Business Name): LARI LIANE KIPLE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 K ST
LINCOLN NE
68508-2949
US

IV. Provider business mailing address

7333 S 96TH CT
LINCOLN NE
68526-6035
US

V. Phone/Fax

Practice location:
  • Phone: 402-477-3951
  • Fax:
Mailing address:
  • Phone: 402-770-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number735428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: