Healthcare Provider Details

I. General information

NPI: 1528055845
Provider Name (Legal Business Name): CHRISTINA RENEE GIPPERICH LSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PEARL ST
LANCASTER PA
17603-3231
US

IV. Provider business mailing address

632 CUMBERLAND ST
LEBANON PA
17042-5230
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-8081
  • Fax: 717-397-8414
Mailing address:
  • Phone: 717-273-1710
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSW122509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: