NPIMap

Individual provider Active NPI

Dawn E Wesenberg, PA

  • Physician Assistant
  • Michigan Center, MI
National Provider Identifier
1720134786
Registry record updated Apr 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006290 Issued in MI
Practice address
4328 Page Ave
Michigan Center, MI 49254
Phone
(517) 764-3609
Fax
(517) 764-3659
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1592-023 WI
Physician Assistant 363A00000X 5601006290 MI Primary

Addresses

Primary practice location

4328 Page Ave
Michigan Center, MI 49254

Mailing address

4328 Page Ave
Michigan Center, MI 49254-1077
Phone (517) 764-3609

Other practice location 1

2316 S Cedar St
Lansing, MI 48910-3152
Phone (517) 887-4302

Other identifiers 2

IdentifierTypeStateIssuer
4190800MedicaidWI
1720134786MedicaidMI

Other names 1

  • Dawn E Nehls Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601006290MIMDPhysician Assistant
1592-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Pain Management SC Past Accepting new patients
Premier Medical Group PC Past Accepting new patients
The Joint and Spine Pain Center PastSince May 26, 2002 Accepting new patients
Advanced Diagnostic Imaging PC Past Accepting new patients
Traverse Observation Physician Services PC Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1720134786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4328 PAGE AVE",
            "city": "MICHIGAN CENTER",
            "state": "MI",
            "postal_code": "492541077",
            "telephone_number": "517-764-3609",
            "fax_number": "517-764-3659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4328 PAGE AVE",
            "city": "MICHIGAN CENTER",
            "state": "MI",
            "postal_code": "49254",
            "telephone_number": "517-764-3609",
            "fax_number": "517-764-3659"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2316 S Cedar St",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489103152",
            "country_code": "US",
            "telephone_number": "517-887-4302",
            "fax_number": "517-887-4437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WESENBERG",
        "first_name": "DAWN",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1592-023",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4190800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720134786",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAWN",
            "last_name": "NEHLS",
            "middle_name": "E",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Michigan Center, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; 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.