Healthcare Provider Details

I. General information

NPI: 1598223612
Provider Name (Legal Business Name): LINDSEY ANN ROOSSIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 STANTON ST
WEST OLIVE MI
49460-8543
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 616-296-1020
  • Fax: 616-296-1030
Mailing address:
  • Phone: 866-611-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number5601004733
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: