Basic Information
| Provider Information | |||||||||
| NPI: | 1992130926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DZIESINSKI | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346643271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 LONG RAPIDS RD | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893542142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2013 | ||||||||
| LastUpdateDate: | 09/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601006794 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 5601006794 | 01 | MI | PERMANENT ID NUMBER | OTHER |