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NPI Code Detail

MEDICARE: LAUREN WEESSIES PA-C

MEDICARE: LAUREN WEESSIES PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601006754MI

General Provider Information

NPI Number : 1083049910
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN WEESSIES PA-C
Provider Business Mailing Address
First Line : 3304 COOLEY CT
Second Line :
City : PORTAGE
State : MI
Zip : 49024-7430
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3304 COOLEY CT
Second Line :
City : PORTAGE
State : MI
Zip : 49024-7430
Country : US
Telephone Number : 269-341-2266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2013
Last Update Date : 05/29/2026

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Directions to “ LAUREN WEESSIES PA-C” Practice Location

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