Healthcare Provider Details

I. General information

NPI: 1134647662
Provider Name (Legal Business Name): ROSALIE JANE LIPFERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COYOTE XING
SANTA FE NM
87508-9374
US

IV. Provider business mailing address

102 COYOTE XING
SANTA FE NM
87508-9374
US

V. Phone/Fax

Practice location:
  • Phone: 603-359-2553
  • Fax:
Mailing address:
  • Phone: 603-359-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: