Healthcare Provider Details

I. General information

NPI: 1568709848
Provider Name (Legal Business Name): LORI ANN DIPPOLD NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

1434 PALMORE RD
POWHATAN VA
23139-7131
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-1700
  • Fax:
Mailing address:
  • Phone: 814-594-1568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number0024170549
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0024170549
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: