Healthcare Provider Details

I. General information

NPI: 1467099705
Provider Name (Legal Business Name): MRS. TESSA MARIE WEYERSHAEUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 BETHLEHEM PIKE
ERDENHEIM PA
19038-8121
US

IV. Provider business mailing address

37 JESSOP LN
HATBORO PA
19040-1342
US

V. Phone/Fax

Practice location:
  • Phone: 215-836-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN665933
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP021786
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: