Healthcare Provider Details

I. General information

NPI: 1821189838
Provider Name (Legal Business Name): VICTOR WEILAND CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRECKENRIDGE COURT SUITE 100
OWENSBORO KY
42303
US

IV. Provider business mailing address

PO BOX 822337
PHILADELPHIA PA
19182-2337
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-2751
  • Fax:
Mailing address:
  • Phone: 866-226-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number017981
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: