Provider Demographics
NPI:1174012066
Name:WIEGEL, PAIGE E (PA-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:E
Last Name:WIEGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:E
Other - Last Name:SPENCE-WIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1600 W GRAND RIVER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2394
Mailing Address - Country:US
Mailing Address - Phone:517-381-6880
Mailing Address - Fax:517-381-6881
Practice Address - Street 1:1600 W GRAND RIVER AVE STE 4
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2394
Practice Address - Country:US
Practice Address - Phone:517-381-6880
Practice Address - Fax:517-381-6881
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical