Healthcare Provider Details

I. General information

NPI: 1275004897
Provider Name (Legal Business Name): TANYA LYNN WEIDEMAN APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA SEIDLING

II. Dates (important events)

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

III. Provider practice location address

101 N MAIN ST
RIVER FALLS WI
54022-2359
US

IV. Provider business mailing address

1038 TOWN HALL RD
RIVER FALLS WI
54022-5803
US

V. Phone/Fax

Practice location:
  • Phone: 715-821-6732
  • Fax: 715-997-8697
Mailing address:
  • Phone: 715-821-6732
  • Fax: 715-997-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1509033
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11485
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: