Healthcare Provider Details

I. General information

NPI: 1538519400
Provider Name (Legal Business Name): EMILY BEATRICE WEIMER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARTIN LUTHER KING DR
MANKATO MN
56001
US

IV. Provider business mailing address

101 MARTIN LUTHER KING DR
MANKATO MN
56001-6460
US

V. Phone/Fax

Practice location:
  • Phone: 507-594-6500
  • Fax:
Mailing address:
  • Phone: 507-594-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.068385
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number.
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: