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1811382625

NPI Code Detail

MEDICARE: DR. DANIELLE NICHOLE TIPPIT MD

MEDICARE: DR. DANIELLE NICHOLE TIPPIT MD

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	207R00000X	Internal Medicine Physician	E-10763	AR
2	207RH0000X	Hematology (Internal Medicine) Physician	69223	MN
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207RX0202X	Medical Oncology Physician	69223	MN

General Provider Information

NPI Number	:	1811382625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE NICHOLE TIPPIT MD

Provider Business Mailing Address
First Line	:	2550 UNIVERSITY AVE W STE 110N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-2001
Country	:	US
Telephone Number	:	651-602-5335
Fax Number	:	651-665-9799

Provider Business Practice Location Address
First Line	:	910 E 26TH ST STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4552
Country	:	US
Telephone Number	:	612-884-6300
Fax Number	:	612-884-6363

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	07/08/2021

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Directions to “ DR. DANIELLE NICHOLE TIPPIT MD” Practice Location

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