Healthcare Provider Details

I. General information

NPI: 1679322689
Provider Name (Legal Business Name): HALLE WEISE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 HIGH ST STE 100
TECUMSEH NE
68450-2443
US

IV. Provider business mailing address

10320 S 27TH ST
ROCA NE
68430-4029
US

V. Phone/Fax

Practice location:
  • Phone: 402-335-2811
  • Fax: 402-335-2826
Mailing address:
  • Phone: 402-806-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: