Provider Demographics
NPI:1427469568
Name:JOSEPH, JIPSON PILLAVEETTIL
Entity type:Individual
Prefix:
First Name:JIPSON
Middle Name:PILLAVEETTIL
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JIPSON
Other - Middle Name:JOSEPH
Other - Last Name:PILLAVEETTIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:717 STAFFORD SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 STAFFORD SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5562
Practice Address - Country:US
Practice Address - Phone:847-929-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX825513163W00000X
IL041.354286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse