Provider Demographics
NPI:1508973330
Name:NIPPER, VALERIE J (PA-C)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:J
Last Name:NIPPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SW CHILDS RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7772
Mailing Address - Country:US
Mailing Address - Phone:503-692-8700
Mailing Address - Fax:503-692-8710
Practice Address - Street 1:7300 SW CHILDS RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7772
Practice Address - Country:US
Practice Address - Phone:503-692-8700
Practice Address - Fax:503-692-8710
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00661363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
133791Medicare ID - Type Unspecified
P29951Medicare UPIN