Healthcare Provider Details

I. General information

NPI: 1760111256
Provider Name (Legal Business Name): CARLA MAE WEISMANTEL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 01/08/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 S HOWELL AVE STE 350
MILWAUKEE WI
53207-6159
US

IV. Provider business mailing address

665 WINDING WOODS DR
LOVELAND OH
45140-8080
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax:
Mailing address:
  • Phone: 513-490-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1155040
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14817-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: