MEDICARE: LINDSEY ANN ROOSSIEN 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
1	207QA0505X	Adult Medicine Physician	5601004733	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5601004733	OTHER	MI	LICENSE

General Provider Information

NPI Number	:	1598223612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY ANN ROOSSIEN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1848
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49443-1848
Country	:	US
Telephone Number	:	866-611-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	15151 STANTON ST
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-8543
Country	:	US
Telephone Number	:	616-296-1020
Fax Number	:	616-296-1030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	12/29/2021

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Directions to “ LINDSEY ANN ROOSSIEN PA-C” Practice Location

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