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NPI Code Detail

MEDICARE: WENDY R. DOWNEY PAC, ATC

MEDICARE: WENDY R. DOWNEY PAC, ATC
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
12255A2300XAthletic Trainer
2363A00000XPhysician Assistant5601005848MI

General Provider Information

NPI Number : 1548319833
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY R. DOWNEY PAC, ATC
Provider Business Mailing Address
First Line : 2298 ANCHOR CT
Second Line :
City : HOLT
State : MI
Zip : 48842-8750
Country : US
Telephone Number : 517-889-5652
Fax Number :
Provider Business Practice Location Address
First Line : 5135 S PENNSYLVANIA AVE
Second Line :
City : LANSING
State : MI
Zip : 48911-4002
Country : US
Telephone Number : 517-887-5922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 09/10/2010

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