MEDICARE: MISS ALLISON MARIE WEIDNER RN

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	163W00000X	Registered Nurse	218348-8	MN

General Provider Information

NPI Number	:	1871162750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALLISON MARIE WEIDNER RN

Provider Business Mailing Address
First Line	:	2256 457TH ST
Second Line	:
City	:	HARRIS
State	:	MN
Zip	:	55032-3776
Country	:	US
Telephone Number	:	320-250-4812
Fax Number	:

Provider Business Practice Location Address
First Line	:	2256 457TH ST
Second Line	:
City	:	HARRIS
State	:	MN
Zip	:	55032-3776
Country	:	US
Telephone Number	:	320-250-4812
Fax Number	:

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

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	03/25/2022

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