Healthcare Provider Details

I. General information

NPI: 1306411897
Provider Name (Legal Business Name): ZOE WOLTJER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZOE KLEM

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH PARK DR
OWOSSO MI
48867-1291
US

IV. Provider business mailing address

200 HEALTH PARK DR
OWOSSO MI
48867-1291
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8666
  • Fax: 989-725-1434
Mailing address:
  • Phone: 989-723-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: