Individual
MS. JODI LYNN TIPPETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN BC
Contact information
Practice address
169 ELM ST, WALTHAM, MA 02453-5356
(781) 894-8440
(781) 894-1202
Mailing address
169 ELM ST, WALTHAM, MA 02453-5356
(781) 894-8440
(781) 894-1202
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
237497
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1303287
MBHP
MA
05
—
1303287
—
MA
01
—
M18633
BCBS
MA
Enumeration date
10/23/2006
Last updated
07/08/2007
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