# MICHELLE RENAE-PIPPEL KELLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154763050
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | PA173678 | OR | Yes |
| 363AS0400X | Surgical Physician Assistant | — | NULL | — |

## Other

- **Enumeration date:** 07/22/2013
- **Last updated:** 01/14/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 206147 | MEDICARE PTAN (GROUP) | IL |
| 01 | — | F400173350 | MEDICARE PTAN (INDIVIDUAL) | IL |