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General NPI Number Information
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NPI Number | 1437549367
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Entity Type | Individual
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Provider Name | CHRISTY WEISS NP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 1181 STATE RT 157 SUITE 200
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 618-288-8850
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Fax | 618-288-8943
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Provider Business Mailing Address
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Address Line | 6810 STATE RT 162 BOX 215
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City | MARYVILLE
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State | IL
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Zip | 62062-8501
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Country | US
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Telephone | 618-391-6405
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Fax | 618-288-4088
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209012501
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License Number State | IL
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