MEDICARE: ALYSSA MARIE WEGLARZ PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP032810	PA

General Provider Information

NPI Number	:	1316736507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIE WEGLARZ PMHNP-BC

Provider Business Mailing Address
First Line	:	932 PENN AVE FL 1
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3017
Country	:	US
Telephone Number	:	484-513-3793
Fax Number	:	484-509-5122

Provider Business Practice Location Address
First Line	:	932 PENN AVE FL 1
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3017
Country	:	US
Telephone Number	:	484-513-3793
Fax Number	:	484-509-5122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	12/01/2025

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