Healthcare Provider Details

I. General information

NPI: 1083049910
Provider Name (Legal Business Name): LAUREN WEESSIES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 COOLEY CT
PORTAGE MI
49024-7430
US

IV. Provider business mailing address

3304 COOLEY CT
PORTAGE MI
49024-7430
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-2266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: