Provider Demographics
NPI:1295732873
Name:WESENER, DEBORAH ANNETTE (MSN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANNETTE
Last Name:WESENER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2298 SPRINGPORT RD
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1475
Mailing Address - Country:US
Mailing Address - Phone:517-784-3950
Mailing Address - Fax:517-817-1681
Practice Address - Street 1:2200 SPRINGPORT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1432
Practice Address - Country:US
Practice Address - Phone:517-784-9356
Practice Address - Fax:517-780-9286
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704154265363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ25398Medicare UPIN
MIN81890006Medicare ID - Type UnspecifiedMEDICARE PART B #