Provider Demographics
NPI:1053514273
Name:LIPOFSKY, ANN DESUTTER (RN, CLD)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:DESUTTER
Last Name:LIPOFSKY
Suffix:
Gender:F
Credentials:RN, CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12604
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-0604
Mailing Address - Country:US
Mailing Address - Phone:303-887-2207
Mailing Address - Fax:503-217-7023
Practice Address - Street 1:2202 DOVER ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-6302
Practice Address - Country:US
Practice Address - Phone:303-887-2207
Practice Address - Fax:503-217-7023
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2011-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
CO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education