Provider Demographics
NPI:1447630603
Name:RIPPCHEN, KARLA (RD, RDN, MMGT)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:RIPPCHEN
Suffix:
Gender:F
Credentials:RD, RDN, MMGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 JUDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1211
Mailing Address - Country:US
Mailing Address - Phone:630-777-5845
Mailing Address - Fax:
Practice Address - Street 1:5615 JUDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1211
Practice Address - Country:US
Practice Address - Phone:630-777-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2023-05-30
Deactivation Date:2020-05-14
Deactivation Code:
Reactivation Date:2021-12-28
Provider Licenses
StateLicense IDTaxonomies
IL164.006229133V00000X
IA100877133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1124769500OtherNPI TYPE 2 BUSINESS
IA1447630603OtherNPI TYPE 1 INDIVIDUAL