Provider Demographics
NPI:1629473335
Name:LIPP, VANESSA (PA-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LIPP
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 1:713 S BLACK AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5383
Mailing Address - Country:US
Mailing Address - Phone:406-390-3254
Mailing Address - Fax:406-624-2700
Practice Address - Street 1:2291 CABALLO AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5657
Practice Address - Country:US
Practice Address - Phone:406-390-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant