Healthcare Provider Details

I. General information

NPI: 1053795674
Provider Name (Legal Business Name): STEPHANIE WEYGAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4159
US

IV. Provider business mailing address

9 BOULDER DR
BURLINGTON MA
01803-1401
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-1400
  • Fax:
Mailing address:
  • Phone: 781-718-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN265907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: