Provider Demographics
NPI:1568263812
Name:LIPPONEN, MEGAN EVA (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EVA
Last Name:LIPPONEN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1541 COLD CREEK PL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3646
Mailing Address - Country:US
Mailing Address - Phone:401-486-1886
Mailing Address - Fax:
Practice Address - Street 1:4741 RANDOLPH RD STE 100-200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2919
Practice Address - Country:US
Practice Address - Phone:704-365-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-15248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant