Basic Information
| Provider Information | |||||||||
| NPI: | 1841254596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIPPRICH | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RN MSN CS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3691 RUTGER AVE | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149776828 | ||||||||
| FaxNumber: | 3149776777 | ||||||||
| Practice Location | |||||||||
| Address1: | 3660 VISTA | ||||||||
| Address2: | 1034 S BRENTWOOD | ||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147261612 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 108018 | MO | X | Nursing Service Providers | Registered Nurse | 364S00000X | 108018 | MO | X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | 425071503 | 05 | MO | MEDICAID |