Most Relevant Information
Provider Data
| NPI Number: | 1003410713 |
| Provider Name: | JACQUELINE INGRID KIPP |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 204822 |
Most Important Dates
| Enumeration Date: | 11/23/2020 |
| Last Updated: | 11/23/2020 |
Provider Practice Location
13802 QUEENS BLVD
BRIARWOOD
NY
114352665
Practice Location Phone/Fax
| Phone: | 3472517737 |
| Fax: |
Provider Mailing Location
16731 109TH AVE
JAMAICA
NY
114332909
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |