Healthcare Provider Details

I. General information

NPI: 1649638404
Provider Name (Legal Business Name): ROBERTA WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 E CARO RD
CARO MI
48723-1236
US

IV. Provider business mailing address

3363 KARG RD
PORT HOPE MI
48468-9300
US

V. Phone/Fax

Practice location:
  • Phone: 989-672-0341
  • Fax:
Mailing address:
  • Phone: 810-434-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704169487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: