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Individual

SUSAN MARIE WASSENHOVE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
812 W 4TH ST, MISHAWAKA, IN 46544-1738
(574) 255-1604
Mailing address
812 W 4TH STREET, MISHAWAKA, IN 46544
(574) 255-1604

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1722
AK
363A00000X
Physician Assistant
2692-23,
WI
363A00000X
Physician Assistant
4398
AZ
363A00000X
Physician Assistant
Primary
5601001412
MI

Other

Enumeration date
06/30/2006
Last updated
02/23/2011
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