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General NPI Number Information
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NPI Number | 1285873448
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Entity Type | Individual
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Provider Name | ANDREA R WEIGAND PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 848 S LA CASSIA DR
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City | BOISE
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State | ID
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Zip | 83705-2253
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Country | US
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Telephone | 208-344-0086
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Fax | 208-466-5359
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | NAMPA
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State | ID
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Zip | 83653-0009
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Country | US
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Telephone | 208-467-4431
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Fax | 208-466-5359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1161
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601005914
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-2785
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License Number State | ID
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