Healthcare Provider Details

I. General information

NPI: 1578513172
Provider Name (Legal Business Name): VERNON P WEYGANDT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 HAYS HILL DR
FENTON MO
63026-3159
US

IV. Provider business mailing address

333 HAYS HILL DR
FENTON MO
63026-3159
US

V. Phone/Fax

Practice location:
  • Phone: 636-326-4716
  • Fax:
Mailing address:
  • Phone: 636-326-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number063885
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: