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General NPI Number Information
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NPI Number | 1770473746
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Entity Type | Individual
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Provider Name | KELSIE LICHTENBERGER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 200 N MADISON ST
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City | MARSHALL
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State | MI
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Zip | 49068-1143
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Country | US
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Telephone | 269-789-7040
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 WOODRIDGE DR
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City | DANVILLE
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State | IL
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Zip | 61832-1669
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Country | US
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Telephone | 217-799-7661
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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 | 5601013268
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License Number State | MI
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