MEDICARE: JESSICA LIPSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28282164A	IN

General Provider Information

NPI Number	:	1568323244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LIPSON RN

Provider Business Mailing Address
First Line	:	4803 DEACON LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-3527
Country	:	US
Telephone Number	:	317-967-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 DEACON LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-3527
Country	:	US
Telephone Number	:	317-967-5345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	12/12/2025

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