Provider Demographics
NPI:1508258427
Name:DIPPE, MEGAN AILEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:AILEEN
Last Name:DIPPE
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-4707
Practice Address - Street 1:660 SW 39TH ST
Practice Address - Street 2:STE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4912
Practice Address - Country:US
Practice Address - Phone:425-793-4700
Practice Address - Fax:425-656-4046
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60707913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant