Provider Demographics
NPI:1295344869
Name:LIPSCOMB, LORETTA ANN
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:ANN
Last Name:LIPSCOMB
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 1:34 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3705
Mailing Address - Country:US
Mailing Address - Phone:304-704-3259
Mailing Address - Fax:
Practice Address - Street 1:219 2ND ST APT 1
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4200
Practice Address - Country:US
Practice Address - Phone:304-591-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant