Healthcare Provider Details

I. General information

NPI: 1366478752
Provider Name (Legal Business Name): ANITA JANE WEISSBURG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FORBES ST SUITE 200
ANNAPOLIS MD
21401-1538
US

IV. Provider business mailing address

1228 FENWICK GARTH
ARNOLD MD
21012-2107
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-6363
  • Fax: 410-263-4086
Mailing address:
  • Phone: 410-263-6363
  • Fax: 410-263-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR071068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: