Individual
MICHELLE RENAE-PIPPEL KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3615 NW SAMARITAN DR, SUITE 210, CORVALLIS, OR 97330-3783
(541) 768-4501
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA173678
OR
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400173350
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
07/22/2013
Last updated
01/14/2021
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