Provider Demographics
NPI:1497504666
Name:TIPANERO, MARY ANN BENOGSUDAN
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:BENOGSUDAN
Last Name:TIPANERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 STEINBECK VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0794
Mailing Address - Country:US
Mailing Address - Phone:701-818-0655
Mailing Address - Fax:
Practice Address - Street 1:5806 STEINBECK VALLEY ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0794
Practice Address - Country:US
Practice Address - Phone:701-818-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV878735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily