Healthcare Provider Details

I. General information

NPI: 1427284298
Provider Name (Legal Business Name): JAN R WEISS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2009
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PENN AVE
SCRANTON PA
18503-1949
US

IV. Provider business mailing address

6900 HAMILTON BLVD REAR
TREXLERTOWN PA
18087-9100
US

V. Phone/Fax

Practice location:
  • Phone: 610-481-0481
  • Fax: 610-481-0486
Mailing address:
  • Phone: 610-481-0481
  • Fax: 610-481-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN197603L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP000581G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: