Basic Information
| Provider Information | |||||||||
| NPI: | 1861678997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WESSLING | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | KELLY | ||||||||
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| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 NEBRASKA ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511051436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122522477 | ||||||||
| FaxNumber: | 7122525920 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 NEBRASKA STREET | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122522477 | ||||||||
| FaxNumber: | 7122525920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2008 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0744 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 001879 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 001879 | 01 | IA | STATE PA-C LICENSE | OTHER | 0744 | 01 | SD | LICENSE | OTHER |