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General NPI Number Information
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NPI Number | 1730305160
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Entity Type | Individual
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Provider Name | DAWN RENEE SCHRECKENGUST PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1850 PIPESTONE AVE. #102-B
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City | BENTON HARBOR
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State | MI
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Zip | 49022-2304
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Country | US
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Telephone | 269-925-8386
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Fax | 269-925-4085
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Provider Business Mailing Address
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Address Line | 2699 60TH ST
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City | FENNVILLE
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State | MI
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Zip | 49408-9414
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Country | US
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Telephone | 269-561-6023
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Fax | 269-925-4085
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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 | 5601002947
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License Number State | MI
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