Healthcare Provider Details

I. General information

NPI: 1346726866
Provider Name (Legal Business Name): LINA MICHELLE WEBER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TALCOTTVILLE RD STE 6
VERNON CT
06066-5261
US

IV. Provider business mailing address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-870-6385
  • Fax:
Mailing address:
  • Phone: 860-870-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0006884
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23.004954
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: