Provider Demographics
NPI:1164457669
Name:SLACHTA, ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:SLACHTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 MAPLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-5448
Mailing Address - Country:US
Mailing Address - Phone:269-397-3244
Mailing Address - Fax:
Practice Address - Street 1:965 S BAILEY AVE
Practice Address - Street 2:SUITE 2-1
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9701
Practice Address - Country:US
Practice Address - Phone:269-639-2772
Practice Address - Fax:269-639-2770
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
5601003083OtherPHYS ASST. LICE NUMBER
MIH06003P03Medicare ID - Type Unspecified