Individual
ELIZABETH JEAN WIERENGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
875 LAURENCE AVE, JACKSON, MI 49202-2966
(517) 787-0544
Mailing address
7883 SEARS RD, HORTON, MI 49246-9513
(517) 563-2072
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601010978
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/13/2018
Last updated
05/25/2022
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