Provider Demographics
NPI:1669861035
Name:SIPE, JANE (L AC/)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SIPE
Suffix:
Gender:F
Credentials:L AC/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MURPHY AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3610
Mailing Address - Country:US
Mailing Address - Phone:707-291-6463
Mailing Address - Fax:
Practice Address - Street 1:310 MURPHY AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3610
Practice Address - Country:US
Practice Address - Phone:707-291-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist