Provider Demographics
NPI:1861678997
Name:WESSLING, ELIZABETH KELLY (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KELLY
Last Name:WESSLING
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 1:1021 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1436
Mailing Address - Country:US
Mailing Address - Phone:712-252-2477
Mailing Address - Fax:712-252-5920
Practice Address - Street 1:1021 NEBRASKA STREET
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105
Practice Address - Country:US
Practice Address - Phone:712-252-2477
Practice Address - Fax:712-252-5920
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0744363AM0700X
IA001879363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001879OtherSTATE PA-C LICENSE
SD0744OtherLICENSE