MEDICARE: MS. DAWN RENEE SCHRECKENGUST PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601002947	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730305160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN RENEE SCHRECKENGUST PA-C

Provider Business Mailing Address
First Line	:	2699 60TH ST
Second Line	:
City	:	FENNVILLE
State	:	MI
Zip	:	49408-9414
Country	:	US
Telephone Number	:	269-561-6023
Fax Number	:	269-925-4085

Provider Business Practice Location Address
First Line	:	1850 PIPESTONE AVE.
Second Line	:	#102-B
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-2304
Country	:	US
Telephone Number	:	269-925-8386
Fax Number	:	269-925-4085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/09/2007

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