Provider Demographics
NPI:1447988092
Name:HIPWELL, EMILY GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:HIPWELL
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 1:1950 SUNNY CREST DR STE 3500
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3646
Mailing Address - Country:US
Mailing Address - Phone:714-408-4249
Mailing Address - Fax:
Practice Address - Street 1:1950 SUNNY CREST DR STE 3500
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3646
Practice Address - Country:US
Practice Address - Phone:714-408-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant