Healthcare Provider Details

I. General information

NPI: 1689182529
Provider Name (Legal Business Name): WESLEY D WEIDLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 34TH ST STE 320
SEATTLE WA
98103-5296
US

IV. Provider business mailing address

400 N 34TH ST STE 320
SEATTLE WA
98103-5296
US

V. Phone/Fax

Practice location:
  • Phone: 206-486-8270
  • Fax: 206-902-9666
Mailing address:
  • Phone: 206-486-8270
  • Fax: 206-902-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61039111
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: