Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0065575 | CO |
NPI | 1033678289 |
---|---|
Provider Name | Nicole Sipfle |
First Address | West Des Moines, IA 50265-2994 |
Second Address | Jbsa Lackland Afb, TX 78236-5300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2019 |
Last Update Date | 08/03/2021 |