Provider Demographics
NPI:1174249692
Name:LIPPOLD, BRETT
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:LIPPOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 E ARKANSAS PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4307
Mailing Address - Country:US
Mailing Address - Phone:402-740-0074
Mailing Address - Fax:
Practice Address - Street 1:12333 E ARKANSAS PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4307
Practice Address - Country:US
Practice Address - Phone:402-740-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1638909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse