Provider Demographics
NPI:1861176786
Name:DIGNAN, MITCHELL PATRICK (PA-C)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:PATRICK
Last Name:DIGNAN
Suffix:
Gender:M
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 1:11235 SW CAPITOL HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7226
Mailing Address - Country:US
Mailing Address - Phone:971-266-9246
Mailing Address - Fax:
Practice Address - Street 1:209 LILLY RD NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5030
Practice Address - Country:US
Practice Address - Phone:360-413-8250
Practice Address - Fax:360-413-8830
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA70068005363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program