Provider Demographics
NPI:1699880716
Name:ENGELSMA, LINDEN J (PA-C)
Entity type:Individual
Prefix:MS
First Name:LINDEN
Middle Name:J
Last Name:ENGELSMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDEN
Other - Middle Name:JANE
Other - Last Name:TEUNISSEN
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:1813 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-458-4010
Practice Address - Fax:920-459-1447
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1631-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41977800Medicaid
ME1014466OtherDEA NUMBER
P99052Medicare ID - Type UnspecifiedMEDICARE PROVIDER