Provider Demographics
NPI:1174532741
Name:NIPP, JULIEANNE M (CFNP)
Entity type:Individual
Prefix:MRS
First Name:JULIEANNE
Middle Name:M
Last Name:NIPP
Suffix:
Gender:F
Credentials:CFNP
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Mailing Address - Street 1:8401 CONSTITUTION AVE NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7604
Mailing Address - Country:US
Mailing Address - Phone:505-727-3800
Mailing Address - Fax:505-727-3808
Practice Address - Street 1:8401 CONSTITUTION AVE NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7604
Practice Address - Country:US
Practice Address - Phone:505-727-3800
Practice Address - Fax:505-727-3808
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMR26903207Q00000X
NMCNP00509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23977060Medicaid
NMR26903OtherSTATE LICENSE NUMBER
NM326368YR41OtherMEDICARE PTAN