Healthcare Provider Details

I. General information

NPI: 1851739767
Provider Name (Legal Business Name): ERIC K WESSEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ALPINE DR
BATESVILLE IN
47006-8477
US

IV. Provider business mailing address

20 ALPINE DR
BATESVILLE IN
47006-8477
US

V. Phone/Fax

Practice location:
  • Phone: 812-932-3224
  • Fax: 812-932-3229
Mailing address:
  • Phone: 812-932-3224
  • Fax: 812-932-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001538A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: