Provider Demographics
NPI:1194073726
Name:RIPPEY, DAVID CLARK (RN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CLARK
Last Name:RIPPEY
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 1:105 S CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:ESPANOAL
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2862
Mailing Address - Country:US
Mailing Address - Phone:505-367-4213
Mailing Address - Fax:
Practice Address - Street 1:105 S CORONADO AVE
Practice Address - Street 2:
Practice Address - City:ESPANOAL
Practice Address - State:NM
Practice Address - Zip Code:87532-2862
Practice Address - Country:US
Practice Address - Phone:505-367-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-72157163W00000X
AZRN166133163W00000X
FLRN1660322163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse