Provider Demographics
NPI:1700236114
Name:VAN DER WEGE, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VAN DER WEGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3613
Mailing Address - Country:US
Mailing Address - Phone:785-621-4990
Mailing Address - Fax:
Practice Address - Street 1:FHSU STUDENT HEALTH
Practice Address - Street 2:600 PARK ST # LL045MU
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-6760
Practice Address - Country:US
Practice Address - Phone:785-628-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77268363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner