Healthcare Provider Details

I. General information

NPI: 1326528050
Provider Name (Legal Business Name): EMILY JEAN WEITZEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JEAN LANOVARA RN

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAN FERNANDO RD
SAN FERNANDO CA
91340-3115
US

IV. Provider business mailing address

5003 SOUTHFORK DR
WICHITA FALLS TX
76310-3717
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-8086
  • Fax:
Mailing address:
  • Phone: 559-304-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNP95009096
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP143015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: