Healthcare Provider Details

I. General information

NPI: 1174012066
Provider Name (Legal Business Name): PAIGE E WIEGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE E SPENCE-WIEGEL PA-C

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W GRAND RIVER AVE STE 4
OKEMOS MI
48864-2394
US

IV. Provider business mailing address

1600 W GRAND RIVER AVE STE 4
OKEMOS MI
48864-2394
US

V. Phone/Fax

Practice location:
  • Phone: 517-381-6880
  • Fax: 517-381-6881
Mailing address:
  • Phone: 517-381-6880
  • Fax: 517-381-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: