Provider Demographics
NPI:1063907608
Name:ZIPPEL, KEVIN (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ZIPPEL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1247
Mailing Address - Country:US
Mailing Address - Phone:607-274-6683
Mailing Address - Fax:607-274-6620
Practice Address - Street 1:55 BROWN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1247
Practice Address - Country:US
Practice Address - Phone:607-274-6683
Practice Address - Fax:607-274-6620
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6865911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6865911OtherUNIVERSITY OF THE STATE OF NEW YORK OFFICE OF THE PROFESSIONS