Individual provider Active NPI

Brooke Isabella Vondaggenhausen

  • Physician Assistant
  • Lansing, MI
National Provider Identifier
1790696904
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4540 Collins Rd Apt 3205
Lansing, MI 48910-8406
Phone
(810) 938-4020
NPI assigned
Sep 15, 2026
Last updated
Sep 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

4540 Collins Rd Apt 3205
Lansing, MI 48910-8406

Mailing address

4540 Collins Rd Apt 3205
Lansing, MI 48910-8406
Phone (810) 938-4020

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)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1789430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1790696904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 COLLINS RD APT 3205",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489108406",
            "telephone_number": "810-938-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 COLLINS RD APT 3205",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489108406",
            "telephone_number": "810-938-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VONDAGGENHAUSEN",
        "first_name": "BROOKE",
        "middle_name": "ISABELLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-15",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; 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.