Provider Demographics
NPI:1578718870
Name:WALTENSPIEL, BOZENA (PA-C)
Entity Type:Individual
Prefix:
First Name:BOZENA
Middle Name:
Last Name:WALTENSPIEL
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 1:3875 ANDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3030
Mailing Address - Country:US
Mailing Address - Phone:586-243-7043
Mailing Address - Fax:
Practice Address - Street 1:1375 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1350
Practice Address - Country:US
Practice Address - Phone:810-667-5574
Practice Address - Fax:810-667-5910
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant