Provider Demographics
NPI:1871789503
Name:WIGGINS-LIPSON, STEPHANIE DENISE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DENISE
Last Name:WIGGINS-LIPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 KENILWORTH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2215
Mailing Address - Country:US
Mailing Address - Phone:614-258-4779
Mailing Address - Fax:
Practice Address - Street 1:2714 KENILWORTH RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2215
Practice Address - Country:US
Practice Address - Phone:614-258-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN237468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse