Healthcare Provider Details

I. General information

NPI: 1659875052
Provider Name (Legal Business Name): PATRICIA ANNE WEISNER MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE WEISNER MD PHD

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 6TH AVE STE 100
TACOMA WA
98405-4048
US

IV. Provider business mailing address

1112 6TH AVE STE 100
TACOMA WA
98405-4048
US

V. Phone/Fax

Practice location:
  • Phone: 253-792-6630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberML60866323
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD.MD.61560365
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: