Provider Demographics
NPI:1962757419
Name:LIPPMAN, ALYSON EK (APN)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:EK
Last Name:LIPPMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 N OAKLAND AVE APT 219
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2350
Mailing Address - Country:US
Mailing Address - Phone:149-396-2624
Mailing Address - Fax:414-209-4346
Practice Address - Street 1:4050 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2301
Practice Address - Country:US
Practice Address - Phone:414-939-6262
Practice Address - Fax:414-209-4346
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6769367A00000X
WI148892367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100069216Medicaid