Healthcare Provider Details

I. General information

NPI: 1356271225
Provider Name (Legal Business Name): JESSE KATHRYN WEEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CIRCLE DR
SEYMOUR WI
54165-1678
US

IV. Provider business mailing address

644 S LINCOLN ST
HORTONVILLE WI
54944-8228
US

V. Phone/Fax

Practice location:
  • Phone: 920-984-3396
  • Fax: 920-833-5146
Mailing address:
  • Phone: 920-475-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number179423-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: