Johdinann Marsha Olive Hartley Waclawski, PAS

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2200 Dendrinos Drive
Suite 102
Traverse City, MI 49684

Phone

(616) 331-5700

Fax

(616) 331-5999

NPI assigned

Nov 14, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIIDAD/Endpoint/IIIDAD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1013731124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CAMPUS DRIVE",
            "address_2": "2015 JAMES H. ZUMBERGE HALL",
            "city": "ALLENDALE",
            "state": "MI",
            "postal_code": "494019403",
            "telephone_number": "616-331-5700",
            "fax_number": "616-331-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 DENDRINOS DRIVE",
            "address_2": "SUITE 102",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "616-331-5700",
            "fax_number": "616-331-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTLEY WACLAWSKI",
        "first_name": "JOHDINANN",
        "middle_name": "MARSHA OLIVE",
        "credential": "PAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-14",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Harrison, COTA/L
• Harry R Borovik MD PC
• Alexis Olivia Ann Hart
• Julie Anna Hartl, MSN, NP-C
• Meranda Sue Hartle
• Randy G Hartman, DPM
• Richard L Hartwell, DO
• James A Harvey, MSPT
• Mary L Harwood, LMSW
• Kylee K Hasbany, BCBA, LBA

• Physician Assistant in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.