MEDICARE: JANET P WEIDNER

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	363A00000X	Physician Assistant	9512741-1206	UT

General Provider Information

NPI Number	:	1629486675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET P WEIDNER

Provider Business Mailing Address
First Line	:	PO BOX 1323
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-1323
Country	:	US
Telephone Number	:	860-966-5066
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CIRCLE OF HOPE DRIVE
Second Line	:	HUNTSMAN CANCER INSTITUTE
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-0000
Country	:	US
Telephone Number	:	860-966-5066
Fax Number	:

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

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	12/16/2021

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Directions to “ JANET P WEIDNER ” Practice Location

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