Provider Demographics
NPI:1265527675
Name:VONAU, DENISE KAY (PA-C)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:KAY
Last Name:VONAU
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 1:10533 E GARTHE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49670
Mailing Address - Country:US
Mailing Address - Phone:231-386-9813
Mailing Address - Fax:
Practice Address - Street 1:93 B FOURTH ST
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-0397
Practice Address - Country:US
Practice Address - Phone:231-271-5990
Practice Address - Fax:231-271-5959
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant