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General NPI Number Information
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NPI Number | 1841700259
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Entity Type | Individual
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Provider Name | LYN IVY LIPAT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 109 RUNDLE LN
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City | SUMMERVILLE
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State | SC
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Zip | 29483-7099
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Country | US
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Telephone | 843-882-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 109 RUNDLE LN
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City | SUMMERVILLE
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State | SC
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Zip | 29483-7099
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 21316
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 21316
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | G163389
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 68624
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License Number State | ID
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