MEDICARE: WAYNE VONSEGGEN 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	100203	NC

General Provider Information

NPI Number	:	1861611527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE VONSEGGEN PA-C

Provider Business Mailing Address
First Line	:	4550 GREENFIELD WAY DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-9757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	WFU BAPTIST MEDICAL CENTER
Second Line	:	MEDICAL CENTER BLVD
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27157-0000
Country	:	US
Telephone Number	:	336-716-9992
Fax Number	:	336-716-6127

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/18/2007

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Directions to “ WAYNE VONSEGGEN PA-C” Practice Location

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