Provider Demographics
NPI:1801519228
Name:SIPP, LIBBY RAE (PA-C)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:RAE
Last Name:SIPP
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 1:129 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-4113
Mailing Address - Country:US
Mailing Address - Phone:605-295-1609
Mailing Address - Fax:
Practice Address - Street 1:129 CANYON VIEW DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-4113
Practice Address - Country:US
Practice Address - Phone:605-295-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant