Healthcare Provider Details

I. General information

NPI: 1932354164
Provider Name (Legal Business Name): LEE ANN WETZEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 03/07/2023
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 GEARY ST SE
ALBANY OR
97322-6842
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-812-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number844
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number168952
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: