Provider Demographics
NPI:1063229904
Name:VIPOND, ROXANNE M
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:M
Last Name:VIPOND
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 1:3622 S 204TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2999
Mailing Address - Country:US
Mailing Address - Phone:308-227-9508
Mailing Address - Fax:
Practice Address - Street 1:3622 S 204TH AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2999
Practice Address - Country:US
Practice Address - Phone:308-227-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE245817843747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider