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General NPI Number Information
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NPI Number | 1720556335
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Entity Type | Individual
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Provider Name | KATELYN D'HAENE PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 1280 E CAMPUS DR
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City | MT PLEASANT
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State | MI
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Zip | 48858-3803
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Country | US
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Telephone | 517-803-6285
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Fax |
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Provider Business Mailing Address
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Address Line | 7125 ORCHARD LAKE RD STE 100
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3616
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Country | US
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Telephone | 248-865-7444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601009593
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License Number State | MI
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