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General NPI Number Information
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NPI Number | 1326596826
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Entity Type | Individual
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Provider Name | MARY JOAN WEINHEIMER NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 700 E BRIGHTON AVE
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City | SYRACUSE
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State | NY
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Zip | 13205-2201
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Country | US
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Telephone | 315-413-3606
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Fax | 315-469-2806
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Provider Business Mailing Address
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Address Line | 301 WINKWORTH PKWY
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City | SYRACUSE
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State | NY
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Zip | 13215-1549
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Country | US
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Telephone | 315-413-3606
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Fax | 315-469-2806
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F301210-1
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License Number State | NY
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