Provider Demographics
NPI:1609835495
Name:LEMMENS, DANIEL A (PA-CU)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:LEMMENS
Suffix:
Gender:M
Credentials:PA-CU
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Mailing Address - Street 1:200 THEDA CLARK MEDICAL PLZ
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2721
Mailing Address - Country:US
Mailing Address - Phone:920-722-7747
Mailing Address - Fax:920-722-7863
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ
Practice Address - Street 2:SUITE 310
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2721
Practice Address - Country:US
Practice Address - Phone:920-722-7747
Practice Address - Fax:920-722-7863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI054-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41925100Medicaid
WIP04076Medicare UPIN
WI41925100Medicaid