Individual
DR. LENAE E VANWAGNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1310 GREENWOOD AVE LOWR LEVEL, JACKSON, MI 49203-3077
(517) 962-0123
(517) 201-8067
Mailing address
1310 GREENWOOD AVE LOWR LEVEL, JACKSON, MI 49203-3077
(517) 962-0123
(517) 201-8067
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301076691
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139374
PREFERRED CHOICES
MI
01
—
200000005064
PHP
MI
01
—
3503810402
BCBS
MI
05
—
4538139
—
MI
01
—
7766500
AETNA
MI
Enumeration date
05/17/2006
Last updated
04/18/2025
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